Pressure-guided evaluation of pulmonary vein occlusion during cryoballoon pulmonary vein isolation for atrial fibrillation compared to contrast-guided approach

Abstract Introduction Single-shot ablation devices (e.g. cryoballoon [CB] technique) have simplified pulmonary vein isolation (PVI) for interventional treatment of atrial fibrillation (AF). Vein occlusion is mainly assessed utilizing contrast media (CM) during CB ablation. However, this approach entails possible risks, including renal impairment and adverse contrast-related allergic reactions. Furthermore, the assessment of pulmonary venography is often challenging and necessitates fluoroscopy exposure. Purpose The primary objective of this study is to compare procedural data and outcome of pressure-guided (PG) vs. conventional (CM) assessment of vein occlusion. Methods and results From 07/2018 to 12/2022, 915 patients with AF (59% paroxysmal) undergoing CB-PVI at our hospital were prospectively enrolled (single-center experience). 369 (40,3%) patients (age 64,5 ± 10 years; 154 females 41,7%) underwent PVI with the use of CM (CM group), while in 546 (59,7%) cases (age 65,3 ± 10 years; 222 females 40,6%) pressure curve assessment (PG group) was exclusively used to guide the procedure (and no contrast was given). Compared with the CM approach, pressure-guided procedures had lower X-ray time (9,5±5min vs 6,4±3,5min, P<0,0001) and X-ray dose (586±546cGy/cm2 vs 96,7±93 cGy/cm2, P<0,0001). Procedure time (PG: 90,3±20,1min, CM: 92,7±22,7 min, p:0,1 ) and ablation time (PG: 1352 ± 365 min, CM: 1393 ± 651 min, p: 0,2) were not different between groups. There was no significant difference observed in the BMI between the two groups, with a mean value of ca. 28.2 ± 4 kg/m2. In 79 redo-procedures, persistent isolation of all pulmonary veins was observed in 11/45 (25%) patients in the CM group and 21/34 (61%) patients in the PG group (p: 0.001). Conclusion Compared to current (CM) assessment of vein occlusion, pressure monitoring is associated with less X-ray exposure during the index procedure and more frequent durable isolation of all PVs during repeat study for recurrence.