title: Direct pressure monitoring accurately predicts pulmonary vein occlusion during cryoballoon ablation.
abstract: Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion. Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible. We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training. Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.
authors.affiliation: Department of Cardiac Electrophysiology, Piedmont Heart Institute, USA. ioanna.kosmidou@piedmont.org
authors.forename: Ioanna
authors.initials: I
authors.lastname: Kosmidou
authors.forename: Shannnon
authors.initials: S
authors.lastname: Wooden
authors.forename: Brian
authors.initials: B
authors.lastname: Jones
authors.forename: Thomas
authors.initials: T
authors.lastname: Deering
authors.forename: Andrew
authors.initials: A
authors.lastname: Wickliffe
authors.forename: Dan
authors.initials: D
authors.lastname: Dan
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001795:Blood Pressure Determination; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography