title: Reduction of radiation exposure in cryoballoon ablation procedures: a single-centre study applying intracardiac echocardiography and other radioprotective measures.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rubesch-Kütemeyer
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Molatta
authors.affiliation: Red Cross Hospital, Frankfurt am Main, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Vogt
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cryoablation; Intracardiac echocardiography; Pulmonary vein isolation; Radiation protection