Achieving a very low fluoroscopy exposure in cryoballon ablation of the pulmonary veins: learning curve of 3D-wide-band dielectric mapping guided ablation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. The novel high resolution wide-band dielectric imaging system improved our strategy of radiation exposure reduction without affecting acute efficacy and safety and giving additional insights on the atrial voltage mapping of the selected patients. Purpose To evaluated the reduction of fluoroscopy use over time during consecutive CB PVI performed with the use of a new 3D mapping system. Methods The study population comprised 89 consecutive patients who underwent in our Centre between Juni 2021 and Juli 2022 to third-generation CB-based PVI with the wide band dielectric system and X-Ray System with enhanced collimation, frame reduction and stored fluoroscopy. All included patients gave written informed consent for TEE and PVI and agreed to the anonymous evaluation of their data for research and quality control. We analyzed the reduction in fluoroscopy use among time. Results The mean radiation exposure data among all patients demonstrate a significant reduction compared with the literature data od CB-PVI: mean fluoroscopy time 3,95 ± 4,12 minutes and mean DAP 15,45 ± 27,18 cGy*cm2. Analysing the learning curve, we identified every 30 patients a significant reduction in X-Ray use achieving a reduction of ca. 80% in the last group of patients compared with the former one. The results are summarized in the Table and Graph. No major complications occurred Conclusion The analysis of the fluoroscopy utilization and exposure during CB-PVI performed with a novel 3D mapping system using wide-band dielectric imaging demonstrated a significant learning curve. A stepwise progressive reduction can be identified leading to a reduction of ca. 80% of radiation use among the last 30 procedures compared to the first 30 ones reflecting individual and team proficiency in using the new imaging system. A very low-radiation exposure during CB-PVI can be achieved with this approach.