Discussion
cataracts, malignancies, musculoskeletal injuries, allergies
RENAL INSUFFICIENCY, ADVERSE EVENTS, SKIN DISEASES, MALIGNANCIES, HEART FAILURE, ALLERGIES, LEAKAGE, CATARACTS, BENDING, COMPLICATIONS
The KODEX-EPD mapping system creates high-resolution cardiac anatomical images by utilizing the unique dielectric properties of biological tissues. When compared to other mapping system, this system has the advantage of non-contact modeling, which can more accurately locate the PV and related accessory structures, increasing the operation's success rate (Fig. 3D reconstruction image of the heart and modeling image of KODEX-EPD mapping and navigation system.Although the proximal seal technique (PST) is a recommended method to avoid ablation within the tubular portion of the PV, there is no qualitative description of the workflow. The use of PST to achieve the vestibular site of PV ablation without a large leakage has not been well described. Thus, in this study, we assessed the feasibility of using a new mapping system, KODEX-EPD, to standardize PST in a group of patients. During the ablation of PV with PST, the injection curve for the KODEX-EPD system displayed three-stage characteristics as follows: the first part of the curve climbed rapidly; the second part of the curve could maintain a high position or a lower slope; and the third part of the curve decreased slowly and eventually stabilized at about half of the peak value. After our center regularly used it to guide the CB ablation of AF, our data indicated that KODEX-EPD system had good sensitivity and specificity compared to X-ray results when the X-ray results showing complete occlusion. In the case of small leakage of X-ray results, the sensitivity and specificity of KODEX-EPD system evaluation results were 93.1% and 82% respectively, which preliminarily proved the value and potential of the KODEX-EPD 3D navigation system in CB ablation surgery. The sensitivity and specificity of the right pulmonary system is slightly lower than those of the left lung, possibly due to the influence of catheter operation. Because a second-generation Medtronic balloon was used in this study, the catheter operation required more space than a fourth-generation balloon or RF ablation catheter to achieve balloon bending and movement among other operations. In terms of catheter and sheath operation, the right PV requires more catheter and sheath operation, and the Achieve electrode is frequently sent into the depths of the PV to meet the requirements of balloon placement and stable position, which may affect the function of occlusion evaluation based on the dielectric principle.Fluoroscopy exposure has a significant negative impact on patients and operators, these risks include acute and subacute skin diseases, musculoskeletal injuries, cataracts, malignancies and genetic defectsSome patients with renal insufficiency, elderly patients with heart failure, and contrast agent allergies may be unable to undergo CB ablation. However, according to one studyOur study further investigated the learning curves of the KODEX-EPD system. When compared to the first five patients, the intraoperative fluoroscopy time, fluoroscopy dose, and contrast agent dosage were all significantly reduced. This demonstrates that after completing the learning curve, intraoperative fluoroscopy exposure and contrast agent dosage can be reduced further. Besides, during the medium-and long-term follow-up, there were no operation-related complications. We can conduct longer follow-up to further verify the safety and effectiveness of KODEX-EPD in CB of AF.As a result, we can conclude that the occlusion evaluation tool has a high sensitivity and specificity for CB ablation. After passing the learning curve, it is possible to reduce fluoroscopy time, fluoroscopy dose, and contrast agent dosage. With the substitution of saline for contrast agent, allowing for 3D visualization of cardiac structure and CB ablation with a low contrast agent dose, the KODEX-EPD system will have high value in the future.We hope that in the future, KODEX-EPD will be able to provide real-time information about the anatomical structure of the heart and PVs, as well as the location of the balloon, through a simpler and more intuitive graphical interface and more accurate 3D navigation. It can assist operators in correctly evaluating the effect of PVI via green electrophysiology, increasing the success rate of AF CB ablation and decreasing the occurrence of adverse events.