Radiation Exposure During Catheter Ablation of Atrial Fibrillation

Abstract

Background-The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation (AF) using the pulmonary vein (PV) approach. Methods and Results-The study included 15 patients with AF and 5 patients each with atrial flutter and atrioventricular nodal reentrant tachycardia (AVNRT) who underwent fluoroscopically guided procedures on a biplane x-ray system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Radiation exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TLDs). Peak skin doses (PSDs), effective radiation doses, and risk of fatal malignancies were all computed. Mean fluoroscopy durations for AF procedures were 67.8Ϯ21 minutes in the right anterior oblique (RAO) and 61.9Ϯ16.6 minutes in the left anterior oblique (LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0Ϯ0.5 Gy in the RAO and 1.5Ϯ0.4 Gy in the LAO projection. The lifetime risk of excess fatal malignancies normalized to 60 minutes of fluoroscopy was 0.07% for women and 0.1% for men. Conclusions-The relatively small amounts of the patient's radiation exposure in this study, despite the prolonged fluoroscopy durations, can be attributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of magnification, and optimal adjustments of the fluoroscopy exposure rates. The resulting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.

Identifying the third dimension in 2D fluoroscopy to create 3D cardiac maps

“…It is important to note that testing of Navik 3D shows the system does not require fluoroscopy exposure beyond the standard of care to generate detailed 3D maps. In fact, the mean fluoroscopy time in our studies was comparable to or less than the existing fluoroscopy times reported for similar studies (11). Navik 3D is likely to reduce fluoroscopy time (and dose) from standard amounts owing to the following: the catheter is visible in 3D and 2D when using Navik 3D; therefore, the physician is provided with better orientation information and is likely to use less fluoro.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…1,1241,1242,1243,1244,1245,1246,1247 Fluoroscopy is required for most components of the procedure, including catheter placement, positioning a multielectrode catheter into the CS, double transseptal catheterization, PV angiography, and LA ablation. A survey of the writing group members reveals that two-thirds use single-plane fluoroscopy, whereas one-third employ biplane.…”

Dose Measurement on Both Patients and Operators during Neurointerventional Procedures Using Photoluminescence Glass Dosimeters

“…[5][6][7] Among these, the PLDs used in this study have been extensively used in clinical and health physics dosimetry because they are sensitive to x-rays with sufficient accuracy through a wide range (ϳ10 Gy to 500 Gy) of detection. Compared with TLDs, PLDs can readout repeatedly until they are annealed to reset to zero.…”