Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

Holl, Marijn J.; Bhagwandien, Rohit; Firouzi, Mehran; Ruiter, W A De; Szili-Török, Tamás; Yap, Sing‐Chien

doi:10.1007/s10840-020-00737-7

Cited by 5 publications

(5 citation statements)

References 20 publications

(39 reference statements)

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“…In other studies, mid‐term follow‐up data after CB2 PVI showed freedom from AF between 64% and 84%, depending on follow‐up intensity and patient characteristics undergoing PVI 15–19 . Our data are in good accordance with follow‐up data after CB2 PVI presented by Holl et al 8 . The authors also used a modified radiation protocol and found that a reduced radiation exposure did not compromise freedom from AF after a mid‐term follow‐up.…”

Section: Discussionsupporting

confidence: 90%

“…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: Discussionsupporting

confidence: 67%

“…During cardiac catheter interventions, radiation exposure to patients and staff should be kept as low as possible 7 . Recently published studies could demonstrate that radiation exposure during CB ablation procedures can be minimized by optimizing the fluoroscopy protocol and/or the ablation strategy without compromising safety and efficacy 8–10 …”

Section: Introductionmentioning

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: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

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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“…Non-fluoroscopic ablation reduced the use of X-rays without compromising the duration, effectiveness, and safety of the procedure. Also, although CBA requires more extensive radiation guidance than RFCA, ways to reduce radiation exposure are being explored in CBA as well [26].…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience

et al. 2021

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Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF.

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“…Over the years, the approach to PVI with a cryoballoon has undergone refinements and modifications to optimize the procedural workflow [5]. These measures include the following: singlefreeze strategy (eliminating a bonus freeze), shorter freezing application (180 versus 240 s), time-to-isolation (TTI)guided ablation, shorter distal tip, radiation reduction, and the use of a figure-of-8 suture [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Use of a novel integrated dilator-needle system in cryoballoon procedures: a zero-exchange approach

Yap

Bhagwandien

Szili-Török

2022

J Interv Card Electrophysiol

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Background Recently, a novel integrated dilator-needle system (AcQCross Qx, Acutus Medical) was introduced to reduce the number of exchanges for a transseptal access. This system can be used in combination with large bore sheaths. In this pilot study, we evaluated the safety and efficacy of a zero-exchange approach with the AcQCross system in cryoballoon procedures. Methods In this retrospective single-center study, we included 40 patients (AcQCross: n = 20; control group: n = 20) who underwent a cryoballoon procedure for the treatment of atrial fibrillation. In the AcQCross and control group, patients underwent ablation with POLARx (Boston Scientific) and Arctic Front Advance Pro (AFA-Pro, Medtronic) in equal numbers (n = 10). In the AcQCross group, the AcQGuide Max sheath (Acutus Medical) was used in all POLARx cases. Results The baseline characteristics of the study population were comparable between groups. In the AcQCross group, there was a reduction in procedure time (49.7 ± 9.0 min vs. 59.6 ± 8.1 min, P < 0.001) and time from puncture until balloon delivery (15.5 ± 6.8 min vs. 21.5 ± 7.4 min, P = 0.01) in comparison with the control group. The balloon in body time, fluoroscopy time, number of cryoapplications, and biophysical parameters were similar between groups. There was one temporary phrenic nerve injury in the AcQCross group. Importantly, no signs of air embolism were noted with the AcQGuide Max sheath. Conclusions The use of the novel AcQCross system improves procedural efficacy in cryoballoon procedures by reducing the number of exchanges.

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Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

Cited by 5 publications

References 20 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

Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience

Use of a novel integrated dilator-needle system in cryoballoon procedures: a zero-exchange approach

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