Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review

Abstract

Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is a main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.

Utilization of and perceived need for simulators in clinical electrophysiology: results from an EHRA physician survey

“…Simulators have been tested for catheter placement and manipulation, transseptal puncture, three-dimensional mapping and ablation system or for cardiac pacing, CRT, and left atrial appendage (LAA) closure, providing a significant improvement in manual skills and knowledge and reducing radiation exposure. 3 , 4 , 8–11 , 21–23 Improvement in fellows’ performance has been associated with a decreased amount of help from supervisors, decreased procedural steps times, and decreased fluoroscopy. 9 …”

“…This process is time-consuming and sometimes frustrating for both the young trainee operator and the senior electrophysiologists; since during this learning curve period, performances are often suboptimal and may expose the patient to an increased risk of complications 2 or to a higher dose of radiation. 3 , 4 …”

“…Procedural outcomes in terms of efficacy and reduced complications’ rate are clearly related with increased operator’s experience and procedure volumes; thus, simulators may be crucial not only to acquire basic manual skills both in EP and cardiac pacing but also especially to address the introduction and development of new technologies. 3 , 4 , 8–11 The aim of this survey was therefore to investigate the current use in clinical practice and the perceived need of virtual training in EP across different EP centres.…”

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

“…Electrophysiologists should be familiar with measures that reduce radiation exposure of patients and cath lab personnel, which include, but are not limited to, fluoroscopy system customization, workflow adaptations (frame rate, collimation, cine, projection angle, sensitive areas), and shielding measures. 764 , 765 …”

The Influence of Different Multipolar Mapping Catheter Types on Procedural Outcomes in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

“…MMCs are extensively employed in these procedures, offering supplementary insights into left atrium geometry creation, voltage mapping, complex fractionated atrial electrograms, validation of isolated pulmonary veins, and identification of reconnected or atrial fibrotic regions. Notably, they play a pivotal role in reducing both mapping and fluoroscopy time significantly [9][10][11][12]. Furthermore, their utility extends to facilitating the achievement of zero-fluoroscopy approach during PVI procedures [13].…”