Abstract 333 Minimizing radiation in cryoballon-based ablation of the pulmonary veins through a novel high-resolution wide-band dielectric imaging system and very low X-ray settings

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y

Minimizing radiation in cryoballon-based ablation of the pulmonary veins through a novel high-resolution wide-band dielectric imaging system and very low X-ray settings

J. Walaschek¹, V. Buia¹, D. Bastian¹, I. My¹, H. Rittger¹, L. Vitali-Serdoz¹

¹Med. Klinik I - Kardiologie, Klinikum Fürth, Fürth;

Purpose
Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. The novel high resolution wide-band dielectric imaging system (KODEX EPD) improved our strategy of radiation exposure reduction without affecting acute efficacy and safety and giving additional insights on the atrial voltage mapping of the selected patients. We evaluated the procedural data of patients undergoing CB PVI with this new 3D electroanatomic mapping system

Methods
The study population comprised 47 consecutive patients who underwent third-generation CB-based PVI with the KODEX EPD system and Siemens Axiom X-Ray System with enhanced collimation, frame reduction and stored fluoroscopy. Our Data were compared to the literature data regarding radiation exposure and fluoroscopy time during CB based PVI without the use of 3D electroanatomic mapping. Primary endpoints were the total dose area product (DAP) and the fluoroscopy time.

Results
Our median DAP per procedure has been 4 cGy*cm2, challenging the median DAP in the recent literature from two high volume centers being about 389 to 1129 cGy*cm2 in CB based PVI. Our median fluoroscopy time was 4 minutes, again challenging the mean fluoroscopy time reported in the literature of around 10 to 14,5 minutes in both CB PVI. Our mean mapping left atrium mapping time using Kodex was of about 7 minutes.ConclusionUsing a modified fluoroscopy protocol and the novel high resolution wide-band dielectric imaging system in CB based PVI can significantly reduce radiation exposure and fluoroscopy time, with a small impact on the total procedural time.

	Cryoballoon ablation	Cryoballoon ablation + 3D mapping system
N° of patients	Literature data: a)60 b)207	47
Fluoro time (min) median, IQR	<!--[if !supportLists]-->a) <!--[endif]-->10[8-12] b) 14,5 [7]	4[2-8]
*DAP cGycm2**	<!--[if !supportLists]-->a) <!--[endif]-->389[285-550] <!--[if !supportLists]-->b) <!--[endif]-->1129 [1259]	8[4-24]

https://dgk.org/kongress_programme/ht2022/aP322.html