Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections.

Abstract

Background. Catheter ablation of accessory atrioventricular (AV) connections has been demonstrated to be effective in more than 85% of patients. One of the risks of this procedure is radiation exposure during the fluoroscopic imaging necessary to guide catheter manipulation. The objective of the present study was to measure the radiation received by patients and physicians during radiofrequency catheter ablation and to estimate the resultant somatic and genetic risks.Methods and Results. Radiation exposure to patients and physicians was measured during attempts at radiofrequency catheter ablation of accessory AV connections in 31 consecutive patients. Radiation exposure was measured using thermoluminescent sensors placed on the patient and on the physician. Somatic and genetic risks were estimated based on the radiation levels recorded using these sensors. The durations of fluoroscopy and of the catheter ablation procedure were recorded for each patient. Catheter ablation was successful in 28 of 31 patients (90%). Mean±SD duration of fluoroscopy was 44+±40 minutes. The largest patient radiation dose was measured over the ninth vertebral body posteriorly (median, 7.26 rem [roentgen equivalents man]; range, 0.31-135.7 rem). Median radiation dose to the thyroid was 0.46 rem (range, 0.06-7.26 rem), and median radiation dose to the posterior iliac crest was 2.43 rem (range, 0.01-8.3 rem). The greatest radiation dose to the operator was recorded at the left hand (99 mrem). Mean radiation dose to the operator's eyes was 28 mrem.Conclusions. Radiofrequency catheter ablation of accessory AV connections may result in significant radiation exposure to the patient and to the physician. Each hour of fluoroscopic imaging is associated with a lifetime risk of developing a fatal malignancy of 0.1% and a risk of a genetic defect of 20 per 1 million births. Although these risks must be recognized, they are relatively small compared with the risks associated with alternate approaches to management, including no therapy, antiarrhythmic drug therapy, and surgery.

Radiofrequency catheter ablation guided by intracardiac echocardiography.

“…4 Previous studies have examined the role of echocardiography in guiding ablation procedures. However, localization by transthoracic echocardiography is limited by catheter shaft artifact and proper identification of the catheter tip.8 In an animal model, a transponder catheter system using transthoracic echocardiographic guidance demonstrated precise localization of an electrode catheter,9 but this technique has not been performed in humans.…”

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

“…Calkins et al 9 and Koovor et al 11 used 6 and 41 TLDs, respectively, attached to the skin for direct recording of radiation exposure. A third study by Rosenthal et al 12 used fluoroscopy times and technical factors of the x-ray equipment for estimation of radiation exposure.…”

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.…”