P1055Reduction of radiation exposure using an optimized fluoroscopy protocol in cryoballoon ablation does not compromise clinical outcome

Abstract

Background/Introduction Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared to radiofrequency ablation. Previous studies showed that radiation exposure in CB PVI can be reduced by optimizing the fluoroscopy protocol without comprising acute efficacy and safety. Purpose We evaluated the mid-term outcome of an optimized fluoroscopy protocol in patients undergoing CB PVI. Methods The study population comprised 90 consecutive patients who underwent second generation CB-based PVI. The first 46 patients underwent CB PVI with conventional fluoroscopy settings (Group A). In the following 44 patients (Group B) an optimized fluoroscopy protocol was applied consisting of 1) using fluoroscopy instead of filming for determining the pulmonary vein occlusion grade; and 2) optimal collimation of the area of interest. Primary endpoints were the total dose area product (DAP), fluoroscopy time and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure. Results Group B had a lower median DAP (1393 cGycm2 vs. 3232 cGycm2, P < 0.001) and median fluoroscopy time (20 min vs. 24 min, P < 0.001) as compared to group A. The 1-year freedom from documented recurrence of AF after a single procedure was similar among groups (74% in Group A vs. 77% in Group B, P = 0.71). There were no significant differences between both groups for the secondary endpoints, including procedure duration, proportion of patients with complete electrical isolation, and complications. Conclusion Using an optimized fluoroscopy protocol in CB PVI radiation exposure could be reduced with a similar 1-year clinical outcome.