Discussion
We present the first reported case of the use of a novel integrated
dilator and needle system (AcQCross™️ Qx) in combination with a 15F
steerable sheath (Medtronic FlexCathTM) to perform a
cryoballoon procedure, without the need of sheath exchange. So far, a
few experiences with the AcQCross™️ Qx system have been
published1,6,7, which documented safety and improved
procedural efficacy, as the time needed for TSP was significantly lower
in AcQCross Qx groups as compared to traditional TSP approach. The main
novelty of our approach consists in TSP monitoring. While Rizzi et
al.1 and Yap et al.6,7 performed TSP
respectively under transesophageal echocardiography monitoring the
former and intracardiac imaging the latter, we chose to safely perform
TSP with AcQCross™️ Qx system under fluoroscopy monitoring. The
connection to a pressure line by using an Y connector allowed us to
confirm the position of the needle by checking LA pressure after its
protrusion and after that we could safely advance the guidewire into
left superior pulmonary vein. This double check of LA pressure and
fluoroscopically correct guidewire position before advancing the 15 F
steerable sheath provides safety and reduces the need of cardiac imaging
during the procedure. Eventually, AcQcross™️ Qx seems to be a promising
novel TSP system, which has the potential to reduce the need of x-rays,
the risk of air embolism due to sheath exchanges, and the complexity of
TSP preserving safety by using echocardiographic monitoring or the
double check suggested in this paper. Also young electrophysiologists
and EP fellows may benefit from this new technology, as lowering
complexity of this procedure could lead to a steeper learning curve.
Further clinical studies need to be done to verify safety and
feasibility outcomes and to finally assess the effective relevance of
this new technology.