Performance of Two Tools for Pulmonary Vein Occlusion Assessment with a
Novel Navigation System in Cryoballoon Ablation Procedure
Abstract
Background Optimal occlusion of pulmonary vein (PV) is
essential for atrial fibrillation (AF) cryoballoon ablation (CBA). The
aim of the study was to investigate the performance of two different
tools for the assessment of PV occlusion with a novel navigation system
in CBA procedure. Methods In consecutive patients with
paroxysmal AF who underwent CBA procedure with the guidance of the novel
3-dimentional mapping system, the baseline tool, injection tool and
pulmonary venography were all employed to assess the degree of PV
occlusion, and the corresponding cryoablation parameters were recorded.
Results In 23 patients (mean age 60.0 + 13.9 years, 56.5%
male), a total of 149 attempts of occlusion and 122 cryoablations in 92
PVs were performed. Using pulmonary venography as the gold standard, the
overall sensitivity, specificity of the baseline tool was 96.7% (95%
CI 90.0% - 99.1%), and 40.5% (95% CI 26.0% - 56.7%), respectively,
while the corresponding value of the injection tool was 69.6% (95% CI
59.7% - 78.1%), and 100.0% (95% CI 90.6% - 100.0%), respectively.
Cryoablation with optimal occlusion showed lower nadir temperature
(baseline tool: -44.3 + 8.4 ℃ vs -35.1 + 6.5 ℃, p < 0.001;
injection tool: -46.7 + 6.4 ℃ vs -38.3 + 9.2 ℃, p < 0.001) and
longer total thaw time (baseline tool: 53.3 + 17.0 s vs 38.2 + 14.9 s, p
= 0.003; injection tool: 58.5 + 15.5 s vs 41.7 + 15.2 s, p <
0.001) compared with those without. Conclusions Both tools were
able to accurately assess the degree of PV occlusion and predict the
acute cryoablation effect, with the baseline tool being more sensitive
and the injection tool more specific.