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Radiation exposure in cryoballoon ablation compared to radiofrequency ablation with three-dimensional electroanatomic mapping in atrial fibrillation patients

Strahlenexposition bei der Kryoballonablation im Vergleich zur Radiofrequenzablation mit 3-dimensionaler elektroanatomischer Kartierung bei Patienten mit Vorhofflimmern

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Abstract

Background

Catheter ablation for atrial fibrillation (AF) has become an established treatment to control symptoms. AF ablation either by cryoballoon or radiofrequency using three-dimensional (3D) electroanatomical mapping exposes patients and medical staff to increased doses of radiation.

Aim

To compare radiation exposure in patients during cryoballoon ablation compared to 3D electro-anatomic mapping catheter ablation in AF patients.

Methods

A total of 30 patients referred for AF ablation underwent full history taking, 12-lead ECG, echocardiogram, and pulmonary vein isolation either by 3D mapping system or cryoballoon. Procedure duration and fluoroscopy time were collected and analyzed. Radiation exposure was measured using thermoluminescent dosimeters placed at different sites related to patients and medical staff.

Result

The procedural time was statistically significantly longer with 3D mapping compared to cryoballoon but showed no significant difference regarding fluoroscopy time. There was a significantly higher radiation skin dose at the right scapular area in the cryoballoon ablation group, in addition to higher peak skin dose compared to the 3D mapping ablation group. There was no statistically significant correlation between peak skin doses and fluoroscopy duration but a statistically significant correlation between peak skin dose and usage of high frame rate and the high dose area product.

Conclusion

Cryoballoon ablation was found to be associated with higher peak skin radiation doses especially in the right scapular area. Knowing dose area product and peak skin dose is more important than fluoroscopy time alone.

Zusammenfassung

Hintergrund

Die Katheterablation bei Vorhofflimmern (VHF) ist eine etablierte Behandlung zur Symptomkontrolle. Bei der Therapie von VHF mittels Kryoballonablation oder Radiofrequenzablation und 3‑dimensionaler (3-D) elektroanatomischer Kartierung werden Patienten und medizinisches Personal erhöhten Strahlendosen ausgesetzt.

Zielsetzung

In dieser Studie wurde die Strahlenbelastung von VHF-Patienten verglichen, bei denen eine Kryoballonablation oder Katheterablation mit elektroanatomischer 3‑D-Kartierung durchgeführt wurde.

Methoden

Insgesamt wurden 30 zur VHF-Ablation zugewiesene Patienten einer umfassenden Anamnese, einem 12-Kanal-Elektrokardiogramm, einer Echokardiographie und einer Pulmonalvenenisolation, entweder mit 3‑D-Kartierungs-System oder mit Kryoballon, unterzogen. Verfahrens- und Durchleuchtungsdauer wurden dokumentiert und analysiert. Die Strahlenbelastung wurde mithilfe von Thermolumineszenzdosimetern gemessen, die an verschiedenen Körperstellen von Patienten und medizinischem Personal angebracht waren.

Ergebnisse

Die Verfahrensdauer war bei 3‑D-Kartierung statistisch signifikant länger als bei Einsatz eines Kryoballons. Bezüglich der Durchleuchtungsdauer zeigte sich dagegen kein signifikanter Unterschied. In der Kryoballonablationsgruppe war die Strahlendosis auf der Haut des rechten Schulterblatts signifikant erhöht, neben einer höheren Spitzendosis auf der Haut verglichen mit der 3‑D-Kartierungs-Ablationsgruppe. Es fand sich keine statistisch signifikante Korrelation zwischen Spitzenhautdosen und Durchleuchtungsdauer, aber eine statistisch signifikante Korrelation zwischen Spitzenhautdosis und Nutzung einer hohen Bildrate sowie hohem Dosis-Flächen-Produkt.

Schlussfolgerung

Für die Kryoballonablation ergab sich eine Assoziation mit höheren Spitzenstrahlendosen auf der Haut, insbesondere im Bereich des rechten Schulterblatts. Das Dosis-Flächen-Produkt und die Spitzenhautdosis zu kennen, ist wichtiger als die alleinige Durchleuchtungsdauer.

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Ain Shams University, Ramsis street, Abbaseya, 11517, Cairo, Egypt

    Ahmed Nabil Ali MD &  Said Abd-El-Hafeez Khalid MD

  2. Egyptian Nuclear and Radiological Energy Authority (ENRRA), Cairo, Egypt

    Hisham Kamal-Eldin Ali MSc &  Wael Ali El-Khouly

Authors
  1. Ahmed Nabil Ali MD
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  2. Hisham Kamal-Eldin Ali MSc
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  3. Said Abd-El-Hafeez Khalid MD
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  4. Wael Ali El-Khouly
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Correspondence to Ahmed Nabil Ali MD.

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Conflict of interest

A. N. Ali, H.K.‑E. Ali, S.A.‑E.‑H. Khalid, and W.A. El-Khouly declare that they have no competing interests.

This study was approved by Ain Shams University ethical committee according to the ethical guidelines of the 1975 declaration of Helsinki as revised in 2008. Informed consent was obtained from all individual participants included in the study.

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Ali, A.N., Ali, H.KE., Khalid, S.AEH. et al. Radiation exposure in cryoballoon ablation compared to radiofrequency ablation with three-dimensional electroanatomic mapping in atrial fibrillation patients. Herzschr Elektrophys 32, 99–107 (2021). https://doi.org/10.1007/s00399-020-00738-z

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  • DOI: https://doi.org/10.1007/s00399-020-00738-z

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