Abstract
PurposePulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with 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. We evaluated the mid-term outcome of a modified fluoroscopy protocol in patients undergoing CB PVI.MethodsThe 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, historic control group). In the following 44 patients (group B), a modified fluoroscopy protocol was applied consisting of (1) visualization of degree of PV occlusion only by fluoroscopy (no cine runs); (2) increased radiation awareness. Primary endpoints were the total dose area product (DAP), fluoroscopy time, and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure.ResultsGroup 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 with 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.ConclusionUsing a modified fluoroscopy protocol and increased radiation awareness, radiation exposure can be significantly reduced in CB PVI with a similar 1-year clinical outcome.
Highlights
Pulmonary vein isolation (PVI) is the cornerstone of invasive treatment of symptomatic drug-refractory atrial fibrillation (AF)
A total of 44 patients underwent the ablation using the modified fluoroscopy protocol starting from June 2017
There were no differences in other baseline characteristics; especially, the type of AF was similar between both groups, with the majority of patients having paroxysmal AF
Summary
Pulmonary vein isolation (PVI) is the cornerstone of invasive treatment of symptomatic drug-refractory atrial fibrillation (AF). The two most frequently used ablation techniques for PVI are radiofrequency (RF) ablation followed by cryoballoon (CB) ablation. With RF ablation, continuous circumferential lesions are created around the pulmonary veins (PV) usually by point-by-point ablation. J Interv Card Electrophysiol (2021) 60:287–294 without compromising acute efficacy and safety [6, 7]. The aim of the present study is to evaluate the acute and mid-term outcome of a modified fluoroscopy protocol and increased radiation awareness in patients undergoing secondgeneration CB ablation
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