Impact of Obesity on Overall Radiation Exposure for Patients Who Underwent Radiofrequency Ablation of Atrial Fibrillation

Faroux, Laurent; Lesaffre, François; Blanpain, Thierry; Mora, C.; Nazeyrollas, Pierre; Metz, Damien

doi:10.1016/j.amjcard.2019.07.018

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…It has been reported that the radiation dose of preprocedural CT (9.4 ± 5.8 mSv) is drastically greater than that of the ablation procedure (2 ± 2 mSv), amounting to 82% of the total radiation dose. 135 In addition to fluoroscopic time, the projection angle, position, collimation, frame rate, pulse rate, magnification, use of cine, and body status also affect the radiation dose. Knowledge of the practical use of fluoroscopy is crucial.…”

Section: Reducing Radiation Exposurementioning

confidence: 99%

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

Nogami¹,

Kurita²,

Kusano³

et al. 2022

Journal of Arrhythmia

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Section: Reducing Radiation Exposurementioning

confidence: 99%

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

Nogami¹,

Kurita²,

Kusano³

et al. 2022

Journal of Arrhythmia

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“…Fluoroscopy time duration was significantly greater for higher BMI patients. A greater x‐ray radiation exposure in obese patients undergoing AF ablation was previously observed by Faroux et al, 26 but it was largely due to the CT scan that was not routinely performed in our study. Wylie et al 27 observed similar fluoroscopy time, but radiation exposure was higher in obese patients, due to the higher energy needed for visualization across a larger body.…”

Section: Discussionmentioning

confidence: 55%

Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients

Malaspina

Brasca

Iacopino

et al. 2021

Pacing Clinical Electrophis

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Background Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB‐PVI in a large cohort of overweight and obese patients from the 1STOP project. Methods From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB‐PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m2), overweight (BMI = 25‐30 kg/m2), and obese patients (BMI > 30 kg/m2). Results Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25‐30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA2DS2‐VASc score, and had a number of failed antiarrhythmic drug (AAD). Periprocedural complication rates were similar among the three cohorts. The 12‐month freedom from AF recurrence was 76.4% in the normal BMI group as compared to 79.2% in the overweight and 73.5% in the obese group (p = .35). However, 48% of overweight patients were on AAD treatment during the follow‐up. By multivariate analysis, BMI was not a predictor for AF recurrence following the index CB‐PVI. Conclusion CB‐PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.

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“…24 One study has shown that obese patients receive 75% higher X-ray exposure dose than normal-weight patients, suggesting that obesity is a main factor affecting X-ray exposure dose. 25 Ionizing radiation can lead to many long-term health effects including malignant neoplasms, genetic defects, cataracts, dermatologic issues, and hematologic conditions. 24,26,27 In addition, published data have shown that long-term, low-dose radiation might contribute to the higher risk of lung cancer, and high-dose exposure can be expected to cause pneumonitis and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…It's known to us that as low as reasonably achievable (ALARA) is the basic principle governing medical radiation exposure, highlighting the importance of minimizing radiation exposure to both patients and operators 24 . One study has shown that obese patients receive 75% higher X‐ray exposure dose than normal‐weight patients, suggesting that obesity is a main factor affecting X‐ray exposure dose 25 . Ionizing radiation can lead to many long‐term health effects including malignant neoplasms, genetic defects, cataracts, dermatologic issues, and hematologic conditions 24,26,27 .…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

Gao

Liu

et al. 2022

Cardiovasc electrophysiol

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Introduction: Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). Methods and Results: PubMed/MEDLINE, Embase, and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE versus without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (mean difference [MD], −9.80; 95% confidence interval [CI], −15.57 to −4.04;I 2 = 99%; p < .01), total procedure time (MD, −17.65; 95% CI, −30.22 to −5.09; I 2 = 89%; p < .01), and complications (relative risk [RR], 0.90; 95% CI, 0.87-0.92; I 2 = 20%; p < .01) versus without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (standardized mean difference, −0.91; 95% CI, −1.86 to 0.04; I 2 = 96%; p = .06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98-1.14; I 2 = 0%; p = .13) was comparable between the two groups. Conclusion:In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications versus ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups.

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Impact of Obesity on Overall Radiation Exposure for Patients Who Underwent Radiofrequency Ablation of Atrial Fibrillation

Cited by 10 publications

References 12 publications

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

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