title: Usefulness of Contrast Intracardiac Echocardiography in Performing Pulmonary Vein Balloon Occlusion during Cryo-ablation for Atrial Fibrillation.
abstract: BACKGROUND
  Cryoballoon ablation (CBA) has been proven to be very effective for pulmonary vein (PV) isolation (PVI) if complete occlusion is achieved and conventionally assessed by angiographic injection of contrast within PV lumen. The aim of our study was to assess the usefulness of saline contrast intracardiac echocardiography in guiding CBA with respect to PV angiography.
  
  
  METHODS
  Thirty consecutive patients with paroxysmal atrial fibrillation were randomly assigned fluoroscopy plus color-flow Doppler (n = 15; group 1: an iodinated medium as both angiographic and echographic contrast) or contrast intracardiac echocardiography plus color-flow Doppler (n = 15; group 2: saline contrast) for guidance of CBA.
  
  
  RESULTS
  We evaluated 338 occlusions of 107 PVs. The intracardiac echocontrastography-guided assessment of occlusion, defined as loss of echocontrastographic back-flow to the left atrium after saline injection regardless of the visualization of PV antrum, showed a high level of agreement with the angiographic diagnosis of occlusion. PVI rate was similar in both groups and effectively guided by intracardiac echocontrastography (PVI using ≤ 2 double cryofreezes: 89% of PVs in group 1 vs. 91% in group 2; p=n.s.). Group 2 patients had significantly shorter procedure (127 ± 16 vs. 152 ± 19 minutes; p<0.05) and fluoroscopy times (30 ± 12 vs. 43 ± 9 minutes, p<0.05) and used a lower iodinated contrast (88 ± 26 vs. 190 ± 47 mL, p<0.05).
  
  
  CONCLUSIONS
  PV occlusion and PVI during cryoablation can be effectively predicted by intracardiac saline echocontrastography. This technique reduces procedural time, radiological exposure and iodinated contrast use.
authors.affiliation: Division of Cardiology, S Maria del Carmine Hospital, Rovereto (TN), Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Catanzariti
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Maines
authors.forename: Carlo
authors.initials: C
authors.lastname: Angheben
authors.forename: Maurizio
authors.initials: M
authors.lastname: Centonze
authors.forename: Claudio
authors.initials: C
authors.lastname: Cemin
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergara