Per-operative biophysicals settings and non-fluoroscopic assessment methods of pulmonary vein occlusion during cryoballoon ablation of atrial fibrillation: comparison between two systems

• Main Author: Metais, Denis
• Other Authors: Université de Caen Normandie - UFR Santé (UNICAEN Santé), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Laure Champ-Rigot
• Format: Master Thesis
• Language: French
• Published: HAL CCSD 2021
• Subjects: Fibrillation auriculaire; Ablation percutanée; Cryothérapie; Veines pulmonaires > Maladies; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; Arctic; Human health
• Online Access: https://dumas.ccsd.cnrs.fr/dumas-03552544; https://dumas.ccsd.cnrs.fr/dumas-03552544/document; https://dumas.ccsd.cnrs.fr/dumas-03552544/file/METAIS%20Denis.pdf

Introduction: Cryoballoon ablation is safe and secure for pulmonary vein isolation (PVI) in atrial fibrillation (AF). A novel system POLARx (Px), similar to Arctic Front Advance (AFA) has recently been marketed. We compared per-operative settings and non-fluoroscopic methods to evaluate pulmonary vein occlusion between both systems. Methods: 80 patients who underwent first-time cryoballoon ablation, were included consecutively in our study (Px=41, AFA=39). Results: Procedure and fluoroscopy durations were higher with Px. Cryoablation with Px was associated with lower nadir temperature (-57°C vs. -50°C, p<0.001) and longer thawing time (48s vs. 40s, p=0.037). Pulmonary veins potentials were recorded more often with Px. Time to Isolation was shorter with AFA but the rate of PVI whitin 60 seconds were similar in both groups. One-shot PVI was associated with lower temperature at 30sec, lower nadir temperature, longer thawing time, higher dPV and higher drop of ETCO2. The best cutoff value of dPV and dETCO2 for predicting one-shot PVI were 6.8 mmHg and 2.75 mmHg respectively. In the AFA group, dPV was associated with one-shot PVI (OR=1.23, p=0.026). In the Px group, there was no difference of dPV and ETCO2 between one-shot PVI and more than one-shot PVI. Px system was similar in acute efficacity after a learning curve. Conclusion: Px system has slightly different technical characteristics, with acute efficacity and safety similar to AFA. Non-fluoroscopic methods to assess pulmonary vein occlusion with either PVP or ETCO2 were associated with one-shot PVI, especially with AFA system. Introduction : la cryoablation est une technique sûre et efficace pour l’isolation des veines pulmonaires (IVP) chez les patients en fibrillation atriale (FA). Le nouveau système POLARx (Px) fonctionne sur le même principe général que l’Arctic Front Advance (AFA). Nous avons comparé les différents paramètres per-opératoires et les méthodes d’évaluation de l’occlusion veineuse pulmonaire sans fluoroscopie entre ces deux systèmes. ...