title: Important reduction of the radiation dose for pulmonary vein isolation using a multimodal approach.
abstract: The number of pulmonary vein isolation (PVI) ablation procedures is steadily increasing worldwide resulting in a substantial radiation exposure to patients and operators. The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety.
  
  
  
  First, we assessed radiation exposure for primary PVI procedures over time (2005-2015) at the University Heart Center Freiburg-Bad Krozingen. Second, we prospectively evaluated in 52 patients, the efficacy and safety of a novel radiation reduction program (particularly applying an enhanced fluoroscopy pulse dose-reduction and optimized 3D-mapping system use). In 2035 primary PVI procedures, radiation exposure, assessed as estimated effective dose (eED in mSv, dose area product * 0.002 * conversion factor for females), fluoroscopy-time, and procedure-time decreased significantly from 2005 to 2015 (e.g. eED decreased from 9.3 (interquartile range (IQR) 6.4-13.4) mSv to 0.9 (IQR 0.5-1.6) mSv, p for trend <0.001). Importantly, application of the enhanced radiation reduction program further reduced eED to 0.4 mSv (IQR 0.3-0.6, P < 0.001 vs. control), a value not significantly different from slow-pathway ablation procedures (P = 0.41). Multiple linear regression analysis identified the radiation reduction program as the only independent variable associated with a decrease in radiation exposure.
  
  
  
  Radiation exposure during PVI decreased over the last decade and can further be reduced significantly by the implementation of an enhanced radiation reduction program.
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Lehrmann
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Amir S
authors.initials: AS
authors.lastname: Jadidi
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.affiliation: Department of Anesthesiology, University Heart Center Freiburg/Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Keyl
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Filipe
authors.initials: F
authors.lastname: Carrapatoso
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Trenk
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Weber
authors.affiliation: Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; 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; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Pulmonary vein isolation; Radiation dose