June 2, 2016EP EuropaceOpen Access

Reduction of radiation exposure in cryoballoon ablation procedures: a single-centre study applying intracardiac echocardiography and other radioprotective measures

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Why the study?

Does the use of intracardiac echocardiography and optimized radioprotective measures reduce radiation exposure in patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation?

Structured PICO

Does the use of intracardiac echocardiography and optimized radioprotective measures reduce radiation exposure in patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation?

Population

100 patients undergoing cryoballoon pulmonary vein isolation for treatment of paroxysmal atrial fibrillation (Group 1: n=50, mean age 59 ± 13 years, 25 male; Group 2: n=50, mean age 61 ± 12 years, 29 male).

Intervention

Intracardiac echocardiography (ICE), skipping PV angiography prior to cryoballoon inflation, avoiding fluoroscopy, reducing frame rate, minimizing distance between patient and detector, and applying collimation.

Comparator

Standard cryoballoon ablation without the optimized radioprotective measures (similar preceding patients).

Outcome

Radiation exposure (total fluoroscopy time and dose area product).surrogate

Applying intracardiac echocardiography and optimized X-ray settings during cryoballoon ablation significantly reduces radiation exposure and contrast use without affecting procedure duration, complication rates, or 12-month efficacy.

Implication

ICE with optimized fluoroscopy was associated with lower radiation in CB PVI; leaves open need for prospective outcome trials.

Abstract

AIMS: The population treated with cryoballoon (CB) ablation is relatively young, and radiation protection is of major importance. We aimed to demonstrate that radiation exposure can be markedly reduced by intracardiac echocardiography (ICE) and optimized settings of the X-ray system. METHODS AND RESULTS: We analysed 100 patients undergoing CB pulmonary vein isolation (PVI) for treatment of paroxysmal atrial fibrillation. In 50 consecutive patients (25 male, 59 ± 13 years; Group 1), we used ICE, skipped PV angiography prior to CB inflation, and avoided fluoroscopy whenever possible. Furthermore, we reduced the frame rate, minimized distance between patient and detector, and consequently applied collimation. These patients were compared with 50 similar preceding patients in Group 2 (29 male, 61 ± 12 years). Total fluoroscopy time was reduced from 18 ± 6 min in Group 2 to 12 ± 5 min in Group 1 (P < 0.001). Moreover, the dose area product was significantly lower (1555 ± 1219 vs. 4935 ± 2094 cGycm2, P < 0.001), total freezing time was significantly shortened (1855 ± 399 vs. 2121 ± 756 s, P = 0.031), and contrast media use was significantly reduced (66 ± 25 vs. 109 ± 27 mL, P < 0.001). At the same time, total procedure duration and complication rates did not differ significantly between both groups. After a 12 months follow-up, a similar percentage of patients was free from recurrences (74% in Group 1 vs. 78% in Group 2, P = 0.640). CONCLUSION: Radiation exposure in CB PVI can be markedly reduced without prolonging procedure times, affecting the outcome or complication rates. Moreover, ICE seems to shorten total freezing time.