Radiation Exposure Optimisation During AF Ablations Utilising the Cryoballoon Ablation System

Radiation risk minimisation during cardiac catheterisation, particularly atrial fibrillation (AF) ablation procedures, requires a multifaceted approach involving both technique and technology.

To evaluate radiation dose associated with cryoballoon compared to conventional radiofrequency (RF) AF ablation procedures.

Consecutive patients undergoing AF ablation were collected in a single-centre registry. Radiation and procedural data for index AF ablation procedures using four ablation techniques were compared: RF ablation with and without the anti-scatter grid (RF Grid and RF Gridless), and cryoballoon ablation utilising first and second-generation Medtronic Arctic Front Cryoballoons (Cryo; Arctic Front, Medtronic, Minneapolis, MN, USA), with and without 3D imaging during fluoroscopy (Cryo 3D and Cryo).

We studied 418 patients; 30 RF Grid, 68 RF No Grid, 12 Cryo 3D and 308 Cryo. The dose area product (DAP; Gycm²), adjusted for patient standardised weight of 80kg, was significantly higher for the Cryo 3D (21.91) and RF Grid (7.31) than the Cryo (2.13) and RF Gridless (3.31) groups; as a result, Cryo 3D was discontinued and RF Grid was only used when clinically required. Comparing the remaining groups, DAP for Cryo was significantly lower than RF Gridless (p<0.001) mainly attributable to a difference in fluoroscopy use (13.2 vs. 17.3 mins; p<0.001). Cryo procedure time was also significantly shorter (80 mins vs. 133 mins; p<0.01).

Cryoballoon AF ablations can be performed efficiently using Gridless fluoroscopy techniques achieving significant reduction in radiation exposure and procedure time while maintaining safety and efficacy. In this observational study, cryoballoon AF ablations compare favourably to conventional RF ablations in terms of these parameters.