Experience with UNIVU module to reduce X-ray exposure during atrial fibrillation catheter ablation

Abstract

Catheter ablation (CA) of atrial fibrillation (AF) has become a very common therapy. Considering risks of irradiation exposure, a reduction of fluoroscopy during AF ablation procedures is essential. The UNIVU module, a fluoroscopy image integration module in the CARTO 3 system, aims to reduce irradiation exposure. We sought to evaluate irradiation exposure evolution in our centre during CA of AF since the installation of UNIVU module. Retrospective, monocentric study, including 266 AF catheter ablation (CA) from 01/2016 to 09/2019, with 181 radiofrequency (RF) CA and 85 cryotherapy CA, performed by a single operator. RF procedure performed with CARTO 3 only ( n = 59) were compared to those with CARTO 3 and UNIVU ( n = 122) in terms of fluoroscopy time (FT), dose area product (DAP) and estimated effective dose (ED). The same parameters were collected for cryotherapy procedure during the same period as a comparator. Median FT, DAP and ED were significantly reduced in the “CARTO3 + UNIVU” group compared to the “CARTO 3” group, respectively ( Fig. 1 ). An improvement in the use of the tool resulted in a higher reduction of irradiation in the 2nd year of UNIVU use, to reach a median DAP of 91 cGy.cm 2 [IQ 44–201] and median ED of 0.2mSv [IQ 0.1–0.4] in the “CARTO3 + UNIVU” group ( P < 0.001). In addition, with much higher residual irradiation, the same evolution was observed for cryotherapy procedures, respectively compared before and after UNIVU installation (median FT (12 min [IQ 8.4–15.4] vs. 8.2 min) [IQ 4.5–12.1], P = 0.004), DAP (1000 cGy.cm 2 [IQ 590–1456] vs. 468 cGy.cm 2 [IQ 196–829], P < 0.001) and ED (2 mSv [IQ 1.2–2.9] vs. 0.9 mSv [IQ 0.4–1.7], P < 0.001). The use of the UNIVU module reduces drastically the irradiation during RF ablation procedures of AF.