Minimizing radiation in cryoballon-based ablation of the pulmonary veins through a novel high-resolution wide-band dielectric imaging system

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. 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 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 89 consecutive patients who underwent third-generation CB-based PVI with the wide band dielectric system and X-Ray System with enhanced collimation, frame reduction and stored fluoroscopy. All the transeptal manouver were perfomed under transesofageal guidance. 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 mean DAP per procedure has been 15,45 ± 27,18 cGy*cm2, challenging the mean 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 3,95 ± 4,12 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. No major complications occurred. CONCLUSION: The combined use of an optimized fluoroscopy setting and a novel high resolution wide-band dielectric imaging system in CB based PVI can significantly reduce radiation exposure and fluoroscopy time and is associated to a high procedural safety.