A modified fluoroscopy protocol to minimize radiation exposure during pulmonary vein isolation with second‐generation cryoballoon

Abstract

Background Pulmonary vein isolation (PVI) using second‐generation cryoballoon (CB2) is considered to be safe and effective in the treatment of atrial fibrillation (AF). Reported radiation exposure during PVI with CB2 is higher if compared with other technologies. We investigated acute and mid‐term effects of a modified fluoroscopy protocol to minimize radiation exposure during CB2 PVI with regard to safety and efficacy. Methods The study comprised 180 consecutive patients undergoing CB2 PVI. In the first 100 patients, PVI was performed using conventional fluoroscopy settings (group 1), while the following 80 patients (group 2) received PVI with a modified protocol. The protocol consisted of (a) general reduction of fluoroscopy frame rate to 3/s, (b) avoidance of cine runs and selective PV angiograms, and (c) enhanced radiation awareness. Retrospective data analysis was performed in respect to dose area product (DAP), fluoroscopy time, and freedom from AF during a 12‐month follow‐up. Results Group 2 patients had lower DAP (426 ± 433 vs 3334 ± 2271 cGycm2), fluoroscopy time (13.8 ± 6.3 vs 16.7 ± 5.6 minutes), LA dwell time (49.3 ± 15.5 vs 61.6 ± 16.2 minutes), and procedure time (85.5 ± 22.9 vs 94.9 ± 23.6 minutes); P < .01 for all. One‐year freedom from AF was comparable between both groups (71% group 1 vs 73% group 2, ns). Conclusion Radiation exposure and procedure time during CB2 PVI can be significantly reduced by using a modified fluoroscopy protocol and increased radiation awareness without compromising acute and 1‐year freedom from AF if performed by experienced operators.

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

“…Depending on the energy source for PVI, cryoablation was associated with higher dose area product 7820 (4195-13,853) cGycm 2 versus 7178 (3668-13,423) cGycm 2 (p < .001). In contrast to our data, the fluoroscopy time in this study was not different for radiofrequency catheter ablation with 24 min in comparison to cryoablation with 22(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) min.In a multicenter study, comparing contact force (CF)-guided radiofrequency (RF) with second-generation cryoballoon (CB) ablation Squara et al26 reported a DAP of 4853 cGycm 2 at a mean fluoroscopy time off 19.3 ± 8.2 min in the CB group and a DAP of 4273 cGycm 2 at mean fluoroscopy time of 17.6 ± 11 min in the RF group with comparable efficacy and complication rates in both groups. Procedure times were shorter in the CB group (109.6 ± 40 min) as compared to the RF group (122.5 ± 40.7 min).…”

“…This was highlighted in a small study of 180 patients by Wieczorek et al 29 investigating the effect of different modifications in the fluoroscopy protocol to minimize the radiation exposure in cryoablation procedures. Interestingly they focused on the same issues being standard in our cath‐lab for more than 10 years: a general reduction of fluoroscopy frame rate to 3/s (3.75/s in our center), avoidance of cine runs and selective PV angiograms (cardiac CT in advance of all PVI‐procedures in our center), and enhanced radiation awareness 19 .…”

“…There is a large discrepancy between a tow fold difference in the fluoroscopy time and the at least sevenfold difference in the DAP comparing to the data from Casella et al 4 from a large high volumeelectrophysiology center with experienced operators with the results of our study. The possible reason for this remarkable difference in the resulting DAP for PVI could be both: different awareness of the operators 27,28 and the technical settings of the fluoroscopy (7.5 pulses per min for fluoroscopy, FOV by 20 cm, no collimation in the Casella study).This was highlighted in a small study of 180 patients by Wieczorek et al29 investigating the effect of different modifications in the fluoroscopy protocol to minimize the radiation exposure in cryoablation procedures. Interestingly they focused on the same issues being standard in our cath-lab for more than 10 years: a general reduction of fluoroscopy frame rate to 3/s (3.75/s in our center), avoidance of cine runs and selective PV angiograms (cardiac CT in advance of all PVI-procedures in our center), and enhanced radiation awareness 19.…”