Evaluation of a new ultralow-dose radiation protocol for electrophysiological device implantation: A near-zero fluoroscopy approach for device implantation

Abstract

BACKGROUND Radiation is one of the main hazards of electrophysiological device implantation, and insertion of cardiac resynchronization therapy (CRT) devices in particular is associated with high radiation doses. OBJECTIVE The purpose of this study was to evaluate the impact of a new ultralow-dose radiation protocol on radiation doses, success rate, and safety of electrophysiological device implantations. METHODS In 2018, we established a new ultralow-dose radiation protocol (reduced pulse width, increased thickness of minimum copper filters, reduced detector entrance dose, reduced pulse rate, optimized image postprocessing settings) for de novo device implantation at our hospital. A total of 1173 patients (11% single-chamber devices, 69% dual-chamber devices, 20% CRT devices) were analyzed. Five hundred twelve patients (44%) in the ultralow-dose group were compared to 661 patients (66%) treated during 2017 with a conventional low-dose protocol. RESULTS With the ultralow-dose radiation protocol, effective doses could be reduced by 59% (median 0.25 [interquartile range: 0.11-0.63] vs median 0.10 [interquartile range: 0.03-0.28] mSv; P ,.0001) per procedure without a significant change in procedure time (P 5 .5). This dose reduction could be achieved without decreasing procedure success (P 5 1) or increasing complication rate (P 5 .8). Male gender, higher body mass index, increased procedure and fluoroscopy times, and use of the conventional radiation protocol were independent predictors of higher radiation doses in multivariate regression analysis. CONCLUSION By establishing a new ultralow-dose radiation protocol, we could significantly decrease radiation exposure, reaching the lowest radiation doses for electrophysiological device implantation reported to date.

Contemporary angiography in the diagnosis and treatment of cardiovascular disease

“…This resulted in a median dose of 30 CGycm 2 for single chamber devices and 326 CGycm 2 for CRT devices. (195) By comparison, the doses in the present study are reported as 22 and 410 CGycm 2 , which appear to be similar. A further study in 2019 established a multicentre DRL for device implants.…”

Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination—review and commentary

“…Many EP labs have upgraded their x-ray equipment to program lower frame or pulse rates. In the most aggressive attempt to overhaul all methods to minimize patient and physician exposure, an ultralow-dose radiation protocol was adopted in one German hospital for all pacemaker and defibrillator implants [ 28 ]. Through the combined use of reduced pulse width and rate of emission, increased thickness of copper filters, reduced detector entrance dose, and an optimization of postprocessing image settings, the physicians were able to reduce the effective dose exposure by 59%.…”

Contactless Electrocatheter Tracing within Human Body via Magnetic Sensing: A Feasibility Study

“…Furthermore, the fluoroscopic equipment must necessarily remain in operation throughout the catheter placement procedure providing real-time feedback to the medical operator. This, of course, conflicts with the need to reduce the radiation dose absorbed both by the patient and even more so by the medical operator [ 8 , 9 ]. To try to reduce quantum noise while maintaining a low radiation dose, various image processing techniques have been proposed, and some of these are implemented by modern fluoroscopic systems.…”