A modified fluoroscopy protocol to minimize radiation exposure during pulmonary vein isolation with second‐generation cryoballoon

BACKGROUND: Pulmonary vein isolation (PVI) using second-generation cryoballoon (CB2) is considered to be safe and effective in the treatment of atrial fibrillation (AF). Reported radiation exposure during PVI with CB2 is higher if compared with other technologies. We investigated acute and mid-term effects of a modified fluoroscopy protocol to minimize radiation exposure during CB2 PVI with regard to safety and efficacy. METHODS: The study comprised 180 consecutive patients undergoing CB2 PVI. In the first 100 patients, PVI was performed using conventional fluoroscopy settings (group 1), while the following 80 patients (group 2) received PVI with a modified protocol. The protocol consisted of (a) general reduction of fluoroscopy frame rate to 3/s, (b) avoidance of cine runs and selective PV angiograms, and (c) enhanced radiation awareness. Retrospective data analysis was performed in respect to dose area product (DAP), fluoroscopy time, and freedom from AF during a 12-month follow-up. RESULTS: ), fluoroscopy time (13.8 ± 6.3 vs 16.7 ± 5.6 minutes), LA dwell time (49.3 ± 15.5 vs 61.6 ± 16.2 minutes), and procedure time (85.5 ± 22.9 vs 94.9 ± 23.6 minutes); P < .01 for all. One-year freedom from AF was comparable between both groups (71% group 1 vs 73% group 2, ns). CONCLUSION: Radiation exposure and procedure time during CB2 PVI can be significantly reduced by using a modified fluoroscopy protocol and increased radiation awareness without compromising acute and 1-year freedom from AF if performed by experienced operators.