Arrhythmias & electrophysiology
Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during cryoballoon ablation of atrial fibrillation: the SWEET-Cryo strategy
Authors' conclusion
In contrast to conventional protocols and regardless of the operator's experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI.
Study context
- Population
- Patients with paroxysmal or persistent atrial fibrillation (AF) undergoing cryoballoon pulmonary vein isolation
- Participants
- 100 patients
- Exposure
- SWEET-Cryo strategy vs conventional fluoroscopy during cryoballoon pulmonary vein isolation (CB-PVI)
- SWEET-Cryon = 50
- Conventional fluoroscopyn = 50reference
- Outcome
- Fluoroscopy time and dose area product
Methodological detailstwo operators with different levels of expertise
- Two operators with different levels of expertise
Main finding
As reported in the abstract
Fluoroscopy time, senior operator
| Group | Value | Dose area product (DAP) (Gy cm²) |
|---|---|---|
| SWEET-Cryo | mean 2.6 (SD 1.25) min | 5.1 ± 3.8 |
| Conventional fluoroscopy | mean 20.3 (SD 10.8) min | 35.3 ± 22.3 |
Value
SWEET-Cryomean 2.6 (SD 1.25) min
Conventional fluoroscopymean 20.3 (SD 10.8) min
Dose area product (DAP) (Gy cm²)
SWEET-Cryo5.1 ± 3.8
Conventional fluoroscopy35.3 ± 22.3
- SWEET-Cryo vs Conventional fluoroscopy: P < 0.001 — fluoroscopy time (FT) and DAP
Observational data: associations, not effects.
Further findings
FT and DAP, less experienced operator
- Significant reduction in FT with SWEET-Cryo vs control: 6.4 ± 2.5 min vs 32.5 ± 10.05
- P < 0.001
- Significant reduction in DAP with SWEET-Cryo vs control: 13.9 ± 7.7 vs 92.3 ± 63.8
- P < 0.001
Freedom from AF · 33-month median follow-up
- No difference between fluoroscopy strategies
Mean FT in randomly selected cases during follow-up
- Mean FT maintained below 3 min
Safety
Acute and long-term complications · 33-month median follow-up
- No difference between fluoroscopy strategies
Original publication
Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during cryoballoon ablation of atrial fibrillation: the SWEET-Cryo strategy. Europace. Published 27 July 2023. doi:10.
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