Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

Marijn J. Holl, Rohit E. Bhagwandien, Mehran Firouzi, Wouter A. de Ruiter, Tamas Szili-Torok, Sing Chien Yap*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
2 Downloads (Pure)


Purpose: Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. Previous studies showed that radiation exposure in CB PVI can be reduced by optimizing the fluoroscopy protocol without comprising acute efficacy and safety. We evaluated the mid-term outcome of a modified fluoroscopy protocol in patients undergoing CB PVI. Methods: The study population comprised 90 consecutive patients who underwent second-generation CB-based PVI. The first 46 patients underwent CB PVI with conventional fluoroscopy settings (group A, historic control group). In the following 44 patients (group B), a modified fluoroscopy protocol was applied consisting of (1) visualization of degree of PV occlusion only by fluoroscopy (no cine runs); (2) increased radiation awareness. Primary endpoints were the total dose area product (DAP), fluoroscopy time, and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure. Results: Group B had a lower median DAP (1393 cGycm2 vs. 3232 cGycm2, P < 0.001) and median fluoroscopy time (20 min vs. 24 min, P < 0.001) as compared with group A. The 1-year freedom from documented recurrence of AF after a single procedure was similar among groups (74% in group A vs. 77% in group B, P = 0.71). There were no significant differences between both groups for the secondary endpoints, including procedure duration, proportion of patients with complete electrical isolation, and complications. Conclusion: Using a modified fluoroscopy protocol and increased radiation awareness, radiation exposure can be significantly reduced in CB PVI with a similar 1-year clinical outcome.

Original languageEnglish
Pages (from-to)287-294
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Issue number2
Early online date13 Apr 2020
Publication statusPublished - Mar 2021

Bibliographical note

Funding Information:
Dr. Yap has received a research grant from Medtronic and is a consultant for Boston Scientific and Medtronic.

Publisher Copyright:
© 2020, The Author(s).


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