Nonfluoroscopic mapping reduces radiation exposure in ablation of atrial fibrillation

Pellegrino, Pier Luigi; Brunetti, Natale Daniele; Gravina, Daniela; Sacchetta, Daniele; Sanctis, Valerio De; Panigada, Stefania; Biase, Luigi Di; Mantica, Massimo

doi:10.2459/jcm.0b013e328356a4e6

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Simplification of the ablation procedure by single shot ablation systems such as the CB and CB2 has further contributed to PVI popularity, because CB has shortened procedure times and learning curves, and shown non‐inferiority regarding safety and freedom from AF as compared to point‐by‐point RF ablation 2–4,14 . On the other hand, when compared with conventional RF ablation, CB PVI is associated with a prolonged fluoroscopy time/higher radiation exposure, since CB PVI is fluoroscopy guided while RF‐ablation is typically supported by 3D electroanatomical mapping 3–6 . Modifications of radiation modalities by reducing fluoroscopy frame rates, optimizing collimation, omitting cine runs together with selective PV angiographies, and preferring fluoroscopic pa projections, whenever possible can significantly reduce radiation exposure, as shown in our study and demonstrated by others recently 8–10 …”

Section: Discussionmentioning

confidence: 99%

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

Wieczorek

Hoeltgen²

2020

Pacing Clinical Electrophis

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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.

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Section: Discussionmentioning

confidence: 99%

“…In a recently published meta‐analysis, CB PVI was noninferior to RF PVI with respect to safety and efficacy 2 . However, CB PVI is generally associated with an increased radiation exposure compared to RF ablation where catheter guidance can be achieved with three‐dimensional (3D) mapping 3–6 …”

Section: Introductionmentioning

confidence: 99%

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

Wieczorek

Hoeltgen²

2020

Pacing Clinical Electrophis

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“…Compared with some other studies, our studies seems to provide a lower dose of radiation exposure in DAP and AK. [ 5 7 8 ]…”

Section: R Esultsmentioning

confidence: 99%

“…[ 1 2 3 4 ] Radiation exposure can only be reduced but cannot be avoided although the use of three-dimensional electroanatomical (EAM) mapping systems. [ 5 6 ] It is a challenge for the operator to reduce the radiation dose as far as possible.…”

Section: Introductionmentioning

confidence: 99%

Optimized Fluoroscopy Setting and Appropriate Project Position Can Reduce X-ray Radiation Doses Rates during Electrophysiology Procedures

Hou

Yao

et al. 2015

Chinese Medical Journal

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Background:Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays, but X-ray remains indispensable for complex electrophysiology procedures. This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.Methods:From June 2013 to October 2013, 105 consecutive patients who underwent complex ablation were enrolled in the study. After the ablation, the radiation dose rates were measured by two different settings (default setting and optimized setting) with three projection positions (posteroanterior [PA] projection; left anterior oblique [LAO] 30° projection; and LAO 45° projection). The parameter of preset voltage, pulse width, critical voltage, peak voltage, noise reduction, edge enhancement, pulse rate, and dose per frame was modified in the optimized setting.Results:The optimized setting reduced radiation dose rates by 87.5% (1.7 Gy/min vs. 13.6 Gy/min, P < 0.001) in PA, 87.3% (2.5 Gy/min vs. 19.7 Gy/min, P < 0.001) in LAO 30°, 85.9% (3.1 Gy/min vs. 22.1 Gy/min, P < 0.001) in LAO 45°. Increase the angle of projection position will increase the radiation dose rate.Conclusions:We can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system. Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.

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Utility of cardiac imaging in patients with ventricular tachycardia

Hawson¹,

Joshi²,

Al‐Kaisey³

et al. 2023

Indian Pacing and Electrophysiology Journal

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Nonfluoroscopic mapping reduces radiation exposure in ablation of atrial fibrillation

Abstract: A fast nonfluoroscopic electroanatomical mapping system may reduce radiation exposure in RFCA of atrial fibrillation, with preserved success rates.

Cited by 3 publications

References 27 publications

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

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

Optimized Fluoroscopy Setting and Appropriate Project Position Can Reduce X-ray Radiation Doses Rates during Electrophysiology Procedures

Utility of cardiac imaging in patients with ventricular tachycardia

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