Radiation Exposure During Atrial Fibrillation (AF) Ablation Utilising Cryoballoon Technology

Abstract

Background: Recent advances in technology have had a significant impact on the electrophysiology-based treatment of atrial fibrillation (AF). Main areas of impact involve radiation risk and procedure time. We evaluate use of cryo-ablations compared to conventional radiofrequency (RF) ablation procedures. Methods: Details for 292 consecutive patients undergoing index AF ablation were captured into a single-centre registry. Radiation, procedural and outcome data for three ablation techniques were compared: RF ablation with (30) and without (59) the anti-scatter grid (RF Grid and RF Gridless) and cryoballoon ablation (203) utilising the first and second generation Medtronic Arctic Front Cryoballoons (Cryo). The dose area product (DAP; Gy cm2) was adjusted for a standardised patient weight of 80 kg. Results/Discussion: DAP was significantly higher for RF Grid (7.31) than the Cryo (2.09) and RF Gridless groups (3.11). DAP for Cryo was significantly lower than RF Gridless (p < 0.001). Similarly, fluoroscopy time (FT) was significantly different between Cryo and RF Gridless cohorts (13.1 vs. 16.8 min; p < 0.001) as were the procedure times (85 min vs. 146 min; p < 0.001), respectively. There was no significant difference in procedural outcome and complication rates between the three approaches. Conclusion: Cryoballoon technology offers a viable means of significantly improving the efficiency of index AF ablations. Significant reductions in radiation exposure and procedure time while maintaining safety and efficacy were achieved.