Key result
SWEET-Cryo strategy linked to ~87% less fluoroscopy time versus conventional fluoroscopy during cryoballoon ablation.
Why the study?
CB-PVI generally involves higher X-ray exposure than point-by-point radiofrequency PVI, and existing fluoroscopy-reduction strategies mostly rely on costly imaging techniques that limit applicability.
Does the SWEET-Cryo strategy reduce fluoroscopy exposure in patients with paroxysmal or persistent AF undergoing CB-PVI?
Cohort (n=100)
Does the SWEET-Cryo strategy reduce fluoroscopy exposure in patients with paroxysmal or persistent AF undergoing CB-PVI?
Absolute Event Rate: 2.6% vs 20.3%
p-value: p=<0.001
The SWEET-Cryo strategy dramatically reduces fluoroscopy exposure during cryoballoon ablation for atrial fibrillation without compromising efficacy or safety, regardless of operator experience.
May reduce fluoroscopy exposure in cryoballoon AF ablation; observational data leaves open need for randomized confirmation.
Aims Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analysed its impact on fluoroscopy use and acute procedural and clinical outcomes. Methods and results We enrolled 100 patients with paroxysmal or persistent AF undergoing CB-PVI by two operators with different levels of expertise. Patients treated with the SWEET-Cryo strategy (prospective cohort; n = 50) or conventional fluoroscopy (retrospective control cohort; n = 50) were compared. When applied by the senior operator, the SWEET-Cryo strategy significantly reduced the mean fluoroscopy time (FT) (2.6 ± 1.25 vs. 20.3 ± 10.8 min) and mean dose area product (DAP) (5.1 ± 3.8 vs. 35.3 ± 22.3 Gy cm2) compared with those of the control group, respectively (P < 0.001). Significant reductions in FT (6.4 ± 2.5 min vs. 32.5 ± 10.05) and DAP (13.9 ± 7.7 vs. 92.3 ± 63.8) were also achieved by the less experienced operator (P < 0.001). No difference was observed in acute and long-term complications or freedom from AF between fluoroscopy strategies during a 33-month median follow-up. Mean FT was maintained below 3 min in randomly selected cases performed during the follow-up period. Conclusion In contrast to conventional protocols and regardless of the operator’s experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI. The efficacy, safety, or added costs of the ablation procedure were not compromised.
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Muñoz et al. (2023) conducted a cohort in Paroxysmal or persistent atrial fibrillation (n=100). SWEET-Cryo strategy vs. Conventional fluoroscopy was evaluated on Mean fluoroscopy time (min) for the senior operator (p=<0.001). The SWEET-Cryo strategy significantly reduced mean fluoroscopy time during cryoballoon ablation compared to conventional fluoroscopy (2.6 vs 20.3 min for the senior operator, P<0.001).
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