EFFECTIVE REDUCTION OF RADIATION EXPOSURE DURING CATHETER PROCEDURES THROUGH OPTIMIZATION OF THE ELECTROANATOMICAL MAPPING NAVIGATION SYSTEM AND PULMONARY VEIN ISOLATION PROCEDURE PROTOCOL

Abstract

Introduction. Pulmonary vein isolation (PVI) through radiofrequency ablation (RFA) is the most common method of catheter-based treatment for atrial fibrillation (AF). Electrophysiologists are increasingly focusing on techniques that reduce the use of X-ray guidance during catheter procedures due to the potential risks of ionizing radiation to patients and medical staff.

Methods. The aim of this scientific and clinical study is to assess the effectiveness and safety of catheter-based radiofrequency ablation for pulmonary vein isolation (PVI) while minimizing X-ray exposure through optimization of the electroanatomical mapping navigation system and procedural protocol.

Results. The study included 43 patients with different forms of atrial fibrillation. All patients underwent catheter-based radiofrequency ablation for pulmonary vein isolation (PVI) with a focus on reducing X-ray exposure at the M.M. Amosov National Institute of Cardiovascular Surgery from June 2023 to April 2024. To achieve this, an optimized X-ray exposure protocol was used during phases requiring X-ray guidance, and predominantly electroanatomical navigation was employed after transseptal puncture. In all 43 patients, electrical isolation of all veins was successfully achieved. The use of methods to minimize X-ray exposure resulted in a significant reduction in the total dose area product (DAP), total radiation dose, X-ray usage time, and procedure duration compared to traditional approaches. The DAP and total radiation dose in Group A (“Zero-fluoro”) were the lowest (7.29 ± 5.16 Gy·cm² and 76.62 ± 70.82 mGy) and significantly differed from those in Group B (“Non Zero-fluoro”) (107.67 ± 97.59 Gy·cm² (p < 0.001) and 882.32 ± 868.62 mGy (p = 0.001)). Procedure duration was shorter in Groups A (“Zero-fluoro”) and Б (“Near Zero-fluoro”) (112.81 ± 30.16 minutes and 138.06 ± 33.44 minutes) compared to Group B (“Non Zero-fluoro”) (167 ± 43.53 minutes), with Group A (“Zero-fluoro”) having a significantly shorter duration compared to Group B (“Non Zero-fluoro”) (p = 0.014). No intraoperative complications were recorded in the sample.

Conclusions. The use of advanced navigation systems to minimize X-ray exposure during catheter-based radiofrequency ablation for pulmonary vein isolation does not increase the risk of intraprocedural complications in patients with paroxysmal or persistent atrial fibrillation. This approach allows for a significant reduction in the total dose area product (DAP) and radiation dose without increasing the duration of the PVI procedure.

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