A novel saline-based occlusion tool allows for dye-less cryoballoon-based pulmonary vein isolation and fluoroscopy reduction

Figures

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  Figure 1. KODEX-EPD offers two options for the operator to visualize the cardiac anatomy. First, a 3D surface image, which provides a conventional shell of the heart chamber and may be rotated freely (B). Second, in an innovative approach, the heart may be opened virtually across the 3D surface and this flattened 3D panoramic view (“PANO” view) offers a visualization of the endocardial surface (A).

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  Figure 2. Immediately following injection, peak amplitude and rate of decay (corresponding to saline washout rate) over 10–15 s and final level are measured at the level of all Achieve electrodes. A slow decay to a novel baseline, as shown by the Waveform Graph (outlined in red) in the example below, displays total PV-occlusion, whereas a fast amplitude decay would indicate a leak (not shown). Furthermore, occlusion quality of the target PV is color-coded and, in this case, shows complete occlusion of the RSPV (green circle). Achieve catheter positions in right superior pulmonary vein (RSPV). RIPV, right inferior pulmonary vein; LIPV, left inferior pulmonary vein; LAA, left atrial appendage.

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  Figure 3. During the assessment of pulmonary vein (PV) occlusion with (A) dye and (B) saline injection, the inherent characteristic physical differences of the two fluids may impact the output of the PV occlusion evaluation. In this example, the injected dye is embedded and sensed by only four of the Archive’s electrodes (colored green, Figure 1A). In contrast, the injected saline has successfully embedded in all the electrodes (eight colored green, Figure 1B). Accordingly, dye injection has erroneously yielded a false-positive identification of a residual PV to LA leak (suboptimal partial PV occlusion, while the saline injection assessment has correctly indicated (true-positive) occlusion of the PV.