RADIATION EXPOSURE IN ACCESSORY PATHWAY ABLATION PROCEDURES IN CARDIAC ELECTROPHYSIOLOGY: A RETROSPECTIVE ANALYSIS
Radiation exposure in accessory pathway ablation procedures
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2021.1.12258Keywords:
accessory pathway, catheter ablation, dose-area product, fluoroscopy time, radiation exposureAbstract
Background. Radiofrequency catheter ablation (CA) has been the treatment of choice in patients with accessory pathway (AP)-mediated tachycardias. Most of these procedures are done under fluoroscopic guidance, leading to significant radiation exposure to the patient and the laboratory personnel. In this analysis, we have looked at the amount of radiation exposure in AP CA procedures performed without the support of a three-dimensional electroanatomic mapping system. We have analyzed changes in exposure indices over the study period and the impact of change in fluoroscopy frame rate (FFR).
Objectives. The objectives of this study are to quantify radiation exposure in accessory pathway ablation procedures; to analyze the radiation exposure trend over time; and to evaluate the effect of fluoroscopy frame rate reduction on the radiation exposure indices in these procedures.
Methods. All the AP ablation procedures performed at our institute from January 2016 to December 2019 were retrospectively analyzed. The collected data were age, sex, location of APs based on successful site of ablation on fluoroscopy, procedure time, fluoroscopy time, and dose-area product (DAP). Effective dose (ED) was estimated from DAP. The data of procedures performed before January 2018 (“pre” group) were compared with those of the procedures performed after that date (“post” group). Pre-group procedures were performed at an FFR of 7.5 frames per second (fps), and post-group procedures – at an FFR of 3.75 fps.
Results. The total number of procedures included in the analysis was 635. The mean age of the patients was 39±14 years, and 401 of them (63%) were males. The most common location of the APs was left lateral (38%). Procedure time and radiation indices showed a significant decrease over the study period (p < 0.001). Post group procedures had significantly shorter procedure time and lower radiation exposure than pre group procedures.
Conclusions. A decrease in the FFR was associated with a significant reduction in radiation exposure in AP ablation procedures
References
Borggrefe M, Budde T, Podczeck A, Breithardt G. High frequency alternating current ablation of an accessory pathway in humans. 10:7. DOI: 10.1016/s0735-1097(87)80200-0
Page RL, Jogler JA, Caldwell MA. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm. 2015;13(4):86. DOI: 10.1016/j.hrthm.2015.09.019
Katritsis DG, Arbelo E, Arribas F. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 41(2020):655–720. DOI: 10.1093/eurheartj/ehz467
Heidbuchel H, Wittkampf FHM, Vano E, Ernst S, Schilling R, Picano E, et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. EP Eur. 2014 Jul 1;16(7):946–64. DOI: 10.1093/europace/eut409
Ali M, Padmanabhan D, Kanjwal K, Ghadei MK, Kottayan A, Banavalikar B, et al. Effect of fluoroscopy frame rate on radiation exposure and in-hospital outcomes in three-dimensional electroanatomic mapping guided procedures. J Arrhythmia. 2021;37:97–102. DOI: 10.1002/joa3.12496
Casella M, Dello Russo A, Pelargonio G, Del Greco M, Zingarini G, Piacenti M, et al. near zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias: the no-party multicentre randomized trial. Europace. 2016 Oct;18(10): 1565–72. DOI: 10.1093/europace/euv344
Rogers DPS, England F, Lozhkin K, Lowe MD, Lambiase PD, Chow AWC. Improving safety in the electrophysiology laboratory using a simple radiation dose reduction strategy: a study of 1007 radiofrequency ablation procedures. Heart. 2011 Mar 1;97(5):366–70. DOI: 10.1136/hrt.2010.204222
Voskoboinik A, Kalman ES, Savicky Y, Sparks PB, Morton JB, Lee G, et al. Reduction in radiation dose for atrial fibrillation ablation over time: A 12-year single-center experience of 2344 patients. Heart Rhythm. 2017 Jun;14(6):810–6. DOI: 10.1016/j.hrthm.2017.02.014
Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M, et al. X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory. J Am Heart Assoc. 2018 Jun 5;7(11). DOI: 10.1161/JAHA.117.008233
Smith IR, Rivers JT, Hayes J, Stafford W, Codd C. Reassessment of Radiation Risks from Electrophysiology Procedures Compared to Coronary Angiography. Heart Lung Circ. 2009 Jun;18(3):191–9. DOI: 10.1016/j.hlc.2008.10.006
See J, Amora J, Lee S, Lim P, Teo W, Tan B, et al. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure. Singapore Med J. 2016 Jul;57(07):390–5. DOI: 10.11622/smedj.2016017
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