Reduction in radiation dose for atrial fibrillation ablation over time: A 12-year single-center experience of 2344 patients

Background Pulmonary vein isolation (PVI) is a well-established treatment of atrial fibrillation (AF), with contact force (CF)–sensing catheters joining 3-dimensional mapping systems and image integration as technological advancements over the last decade. Objective The purpose of this study was to analyze trends in radiation exposure for AF ablation over the last 12 years at our center. Methods We reviewed prospectively collected data of 2344 consecutive PVI procedures for either paroxysmal or persistent AF between January 2004 and December 2015. During this period, all cases used 3-dimensional mapping systems, with 8 software and 2 hardware upgrades. Primary endpoints were fluoroscopy time, absorbed dose (Air Kerma in mGy), and effective dose (mSv). Results In total, 1914 patients underwent initial PVI, and 430 patients underwent redo PVI using radiofrequency energy. Fluoroscopy time, and absorbed and effective doses significantly and progressively decreased over the 12-year period for initial PVI as follows: 2004–2006: 61 ± 27 minutes; 2007–2009: 46 ± 14 minutes, 1365 ± 1369 mGy, 11.3 ± 12.5 mSv; 2010–2012: 31 ± 11, 464 ± 339 mGy, 9.0 ± 10.4 mSv; and 2013–2015: 17 ± 9 minutes, 304 ± 758 mGy, 5.5 ± 6.7 mSv. CF-sensing catheters were used for 357/508 PVI only cases between 2014 and 2015. Fluoroscopy times (11 ± 5 vs 21 ± 8 minutes; P