Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort

Rubesch-Kütemeyer, Vanessa; Fischbach, Thomas; Guckel, Denise; Körber, Britta; Horstkotte, Dieter; Gutleben, Klaus-Jürgen; Nölker, Georg

doi:10.1007/s10840-019-00564-5

Cited by 9 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even these days many authors use the description of “fluoroscopy time” as a measure of radiation related to ablation procedures. However, this may be misleading as there are many other factors that influence radiation exposure such as frame rate, radiation dose per pulse, collimation—each of which will determine effective dose to a far greater degree than exposure time 12,13 . In line with this statement, our registry also showed only a weak correlation between fluoroscopy time and dose.…”

Section: Discussionmentioning

confidence: 56%

Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry

Kosiuk

Fiedler

Ernst

et al. 2020

Clinical Cardiology

View full text Add to dashboard Cite

BackgroundFluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed.HypothesisCurrent norms and quality markers required for optimal clinical routine can be identified.MethodsCenters participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases.ResultsTwenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old).Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2, 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2, 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2, 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2, 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy.Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001).ConclusionExposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.

show abstract

Section: Discussionmentioning

confidence: 56%

Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry

Kosiuk

Fiedler

Ernst

et al. 2020

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Inevitably, CBA had a longer fluoroscopy time which resulted from confirming the CB occlusion in PVs by means of extra contrast injection and fluoroscopy. With the use of intracardiac echocardiography (ICE), the devices and cardiac structures, such as the FlexCath sheath, Achieve catheter, and the PV ostium, are easily visualized and navigated in the procedure, which reduces the need for fluoroscopy ( 12 , 13 ). In recent years, a novel imaging and navigation system, the KODEX-EPD (EPD Solutions, Philips, Best, The Netherlands), has been used in CBA procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins

Xie

Sun

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Aims: To compare the procedural outcomes of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in atrial fibrillation (AF) patients with the common ostium of inferior pulmonary veins (COIPV) and to explore the effect of COIPV on CBA performance through the assessment of anatomical factors.Methods: A total of 18 AF patients with COIPV were included. Pulmonary vein isolation (PVI) was performed with second-generation CBA or RFA. The anatomical characteristics of COIPV and procedural outcomes were collected.Results: The prevalence of COIPV was 0.82% in the enrolled population. PVI was achieved in all pulmonary veins (PVs) without any complications. The “tricircle” strategy was applied for RFA, and the segmental freeze strategy was performed for CBA. Compared with RFA, CBA had shorter procedural time (median: 53.0 vs. 78.0 min, p < 0.001) and longer fluoroscopy time (median: 13.5 vs. 6.0 min, p < 0.001). Higher ovality index of the ostium was seen in patients with ≥4 freezes in inferior PVs [IPVs; 0.95 (0.78–1.05) vs. 0.49 (0.21–0.83), p = 0.047]. During a median of 23.5 months of follow-up, the atrial arrhythmias-free survival after the procedure was comparable between CBA and RFA (p = 0.729).Conclusion: The second-generation CBA is an efficient and safe alternative for RFA in AF patients with COIPV. Anatomical characteristics of COIPV bring the challenge to the procedure performance of RFA and CBA.

show abstract

“… 56 A smaller single-centre study presented data on CB-PVI between 2013 and 2017 in >1000 patients. 57 Procedural changes enabled radiation dose reduction in two recent studies. 57 , 59 Recently, a new 3D-mapping system (Kodex-EPD™) was used in conjunction with the CB and the circular mapping catheter (Achieve™) for PVI, leading to further reduction of radiation dose.…”

Section: Single-shot Devices For Atrial Fibrillation Ablationmentioning

confidence: 99%

Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review

et al. 2023

View full text Add to dashboard Cite

Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is a main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.

show abstract

Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort

Cited by 9 publications

References 18 publications

Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry

Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry

Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins

Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review

Contact Info

Product

Resources

About