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Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort

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Abstract

Purpose

The concern of higher radiation exposure during cryoballoon ablation (CBA) compared with radiofrequency ablation for atrial fibrillation (AF) was raised before. Previously, we compared CBA plus intracardiac echocardiography (ICE) to our former standard approach without ICE. A substantial reduction of radiation exposure without compromising safety or outcome was observed. We now investigate if at all and possibly to which amount radiation reduction can be achieved with growing experience.

Methods

We retrospectively analysed procedure time, dose area product (DAP), fluoroscopy time (FT) and contrast media (CM) use for all patients receiving CBA between 2013 and 2017 for AF.

Results

In 1131 procedures, procedure time decreased significantly between 2013 and 2017 (2013 111 ± 26 min, 2017 99 ± 25 min, p = 0.005). DAP halved between 2013 and 2014 without further significant decline (2013 1428 ± 1276 cGycm2, 2014 725 ± 551 cGycm2, p < 0.001). FT demonstrated a constant decrease from 2013 to 2017 (2013 11.7 ± 5.5 min, 2017 5.1 ± 3.5 min, p < 0.001). CM use did not show a significant reduction comparing 2013 to 2017 (2013 62 ± 19 ml, 2017 59 ± 18 ml, 2013/2017 p = 0.584).

Conclusion

Given the imminent negative effects of radiation, every effort should be undertaken for its reduction. Feasible protocols can be kept simple by technical changes as reducing frame rates and basic radiation reduction strategies such as collimation, but ICE might add additional benefit. With growing experience and awareness of radioprotection, DAP and FT as low as or lower than in radiofrequency ablations seem possible.

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Authors and Affiliations

  1. Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Vanessa Rubesch-Kütemeyer, Thomas Fischbach, Denise Guckel, Britta Körber, Dieter Horstkotte, Klaus-Jürgen Gutleben & Georg Nölker

  2. Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Dieter Horstkotte

Authors
  1. Vanessa Rubesch-Kütemeyer
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  2. Thomas Fischbach
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  3. Denise Guckel
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  4. Britta Körber
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  5. Dieter Horstkotte
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  6. Klaus-Jürgen Gutleben
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  7. Georg Nölker
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Contributions

Concept/design (VRK, GN), data collection (VRK, TF, DG, BK), data analysis/interpretation (VRK, GN), statistics (VRK, GN), drafting article (VRK, GN), critical revision and approval of article (all authors).

Corresponding author

Correspondence to Vanessa Rubesch-Kütemeyer.

Ethics declarations

The study was approved by the institutional review board. Prior to ablation, all patients were selected according to the then current guidelines and written consent was obtained.

Conflict of interest

GN has received honoraria for lectures from Medtronic. The other authors declare that they have no conflicts of interest.

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Rubesch-Kütemeyer, V., Fischbach, T., Guckel, D. et al. Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort. J Interv Card Electrophysiol 58, 169–175 (2020). https://doi.org/10.1007/s10840-019-00564-5

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  • DOI: https://doi.org/10.1007/s10840-019-00564-5

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