Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
Asklepios proresearch, Lohmühlenstr. 5, 20099, Hamburg, Germany.
Europace. 2018 Apr 1;20(4):608-613. doi: 10.1093/europace/eux066.
Procedure times and left atrial dwell times of cryoballoon (CB)-based ablation strategies for atrial fibrillation (AF) are shorter as compared to radiofrequency ablation, yet fluoroscopy times are longer and result in a higher radiation exposure. The objective of this study is to evaluate a modified fluoroscopy protocol aiming at reduction of radiation exposure in CB ablation.
A total of 120 patients with symptomatic AF underwent pulmonary vein isolation (PVI) using the second generation CB and an ablation strategy considering the individual time-to-isolation. The first 60 patients (Group 1) underwent CB-based PVI with conventional fluoroscopy settings. An optimized approach was applied in the following 60 patients (Group 2) by (i) using fluoroscopy instead of filming for verification of pulmonary vein (PV) occlusion after contrast injection, (ii) reducing the frame rate, and (iii) pursuing maximal collimation on the region of interest. A total of 475 PVs were identified and successfully isolated. Median dose area product and fluoroscopy time were significantly shorter in Group 2 as compared to Group 1 [389 (285; 550) cGycm2 vs. 2168 (1355; 3490) cGycm2 (P < 0.0001) and 10 (8; 12) min vs. 14 (11; 19) min (P < 0.0001)]. Additionally, median time-to-isolation of the PVs was significantly shorter in Group 2 [44 (30; 65) s vs. 33 (20; 46) s (P < 0.0001)].
The implementation of an optimized fluoroscopy protocol significantly reduces radiation exposure in CB-based PVI without compromising acute efficacy and safety.
与射频消融相比，基于冷冻球囊（CB）的消融策略治疗心房颤动（AF）的手术时间和左心房停留时间更短，但透视时间更长，导致辐射暴露更高。本研究的目的是评估一种改良的透视协议，旨在减少 CB 消融中的辐射暴露。
共 120 例有症状的 AF 患者接受第二代 CB 行肺静脉隔离（PVI），并采用考虑个体隔离时间的消融策略。前 60 例患者（组 1）接受常规透视设置下的 CB 基于 PVI。接下来的 60 例患者（组 2）采用优化方法，具体为：（i）在对比剂注射后使用透视而非拍摄验证肺静脉（PV）闭塞；（ii）降低帧率；（iii）对感兴趣区域进行最大准直。共识别和成功隔离了 475 条 PV。与组 1 相比，组 2 的剂量面积乘积和透视时间中位数显著缩短[389（285；550）cGycm2 比 2168（1355；3490）cGycm2（P<0.0001）和 10（8；12）min 比 14（11；19）min（P<0.0001）]。此外，组 2 的 PV 隔离中位时间明显缩短[44（30；65）s 比 33（20；46）s（P<0.0001）]。
在不影响急性疗效和安全性的情况下，实施优化的透视协议可显著降低基于 CB 的 PVI 中的辐射暴露。
