Abstract 13727: How much Reduction of Radiation Exposure is Feasible in Ablation Procedures Without Affecting the Outcome? a Single Center Study on Cryoballoon Ablation in Paroxysmal Atrial Fibrillation
Introduction: Cryoballoon (CB) ablation has been widely adopted as a valuable alternative technique in pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (pxAF). The population treated is relatively young and radiation protection is of major importance.
Hypothesis: We aimed to demonstrate that radiation exposure can markedly be reduced by intracardiac echocardiography (ICE) and optimized settings of the Xray system.
Methods: A total of 140 patients were studied. In 57 consecutive patients (31 male, 58±14 years, BMI 26.7±4.2 kg/m2, LA 38±6 mm, LVEF 54.9±0.7) (group 1) undergoing CB PVI for treatment of pxAF, ICE was applied for transseptal puncture, confirmation of PV occlusion, guidance of wires, mapping catheters and CB and monitoring of complications. PV angiography prior to CB inflation was skipped. Thereby, fluoroscopy was avoided whenever possible. During fluoroscopy a reduced frame rate (3/s instead of 7.5/s) was chosen, distance of patient and detector was kept minimal and collimation was applied consequently. The “Care Position” functionality (Siemens, Forchheim, Germany) was used to avoid fluoroscopy during table movements. Patients from group 1 were compared to 73 similar preceding consecutive patients (45 male, 61±12 years, BMI 26.5±3.8 kg/m2, LA 40±6 mm, LVEF 55±3%) (group 2).
Results: No complications occurred. Total fluoroscopy time could be reduced from 18.7±6.2 to 12.1±5.5 s (p<0.0001). Radiation exposure was 1652±1265 μGy*m2 in group 1 compared to 5134±2451 μGy*m2 in group 2 (p<0.0001) Total procedure times were 108.7±23.1 min in group 1 compared to 107.0±25.6 min in group 2 (p=n.s.), total freezing time could be reduced from 2126±706 to 1874±414 s (p=0.01). At 6 month follow-up 74.5 % vs. 84.1 % (p=0.26) were free from recurrences, more patients in group 1 were followed using implantable devices (23 vs. 7%; p=0.01).
Conclusions: Radiation exposure in CB PVI could be markedly reduced without prolonging procedure times or affecting the outcome. Moreover, ICE seems to reduce total freezing times. Twelve-month follow-up will be available and presented at the meeting.
Author Disclosures: V. Rubesch-Kütemeyer: None. S. Molatta: None. M. Hossain: None. F. Koch: None. J. Vogt: Honoraria; Modest; Medtronic. D. Horstkotte: None. K. Gutleben: Honoraria; Modest; Medtronic. G. Nölker: Honoraria; Modest; Medtronic, Biosense Webster.
- © 2014 by American Heart Association, Inc.