Do we need imaging support to minimize radiation exposure in cryo-ablation for atrial fibrillation? The VLADIMIR strategy

Abstract Introduction and objective Cryoballoon pulmonary vein isolation (CB-VPI) is non-inferior to radiofrequency ablation in patients with atrial fibrillation. Although protocols aiming to reduce radiation exposure have been developed, most of them use intracardiac echocardiography (ICE) or electroanatomic mapping (EAM) systems, which significantly increase procedure costs or may not be widely available. Previous studies aiming at fluoroscopy reduction have been published, achieving median fluoroscopy times around 10 minutes. We developed a novel strategy to achieve Very Low rADIoscopic exposure to Minimize Ionizing Radiation during cryoablation of atrial fibrillation (VLADIMIR) (Table 1). The aim of this study was to assess its impact in acute procedural and clinical outcomes. Methods Consecutive patients undergoing CB-VPI were prospectively enrolled, treated with the VLADIMIR strategy and compared to a retrospective cohort of patients having undergone CB-VPI performed by the same operators with conventional fluoroscopy strategy. Primary end-points were fluoroscopy time and total dose area product (DAP). Secondary end-points were intraprocedural or early post-procedural complications. Results A total of 84 patients were enrolled. 50 patients underwent CB-VPI with conventional fluoroscopy strategy and in 34 patients the Vladimir strategy was applied. Vladimir group had significant lower median fluoroscopy time (2.98 min vs 20.65 min, p