Radiation Exposure in Accessory Pathway Ablation Procedures in Cardiac Electrophysiology: A Retrospective Analysis

Abstract

Background. Radiofrequency catheter ablation (CA) has been the treatment of choice in patients with accessory pathway (AP)-mediated tachycardias. Most of these procedures are done under fluoroscopic guidance, leading to significant radiation exposure to the patient and the laboratory personnel. In this analysis, we have looked at the amount of radiation exposure in AP CA procedures performed without the support of a three-dimensional electroanatomic mapping system. We have analyzed changes in exposure indices over the study period and the impact of change in fluoroscopy frame rate (FFR). Objectives. The objectives of this study are to quantify radiation exposure in accessory pathway ablation procedures; to analyze the radiation exposure trend over time; and to evaluate the effect of fluoroscopy frame rate reduction on the radiation exposure indices in these procedures. Methods. All the AP ablation procedures performed at our institute from January 2016 to December 2019 were retrospectively analyzed. The collected data were age, sex, location of APs based on successful site of ablation on fluoroscopy, procedure time, fluoroscopy time, and dose-area product (DAP). Effective dose (ED) was estimated from DAP. The data of procedures performed before January 2018 (“pre” group) were compared with those of the procedures performed after that date (“post” group). Pre-group procedures were performed at an FFR of 7.5 frames per second (fps), and post-group procedures – at an FFR of 3.75 fps. Results. The total number of procedures included in the analysis was 635. The mean age of the patients was 39±14 years, and 401 of them (63%) were males. The most common location of the APs was left lateral (38%). Procedure time and radiation indices showed a significant decrease over the study period (p < 0.001). Post group procedures had significantly shorter procedure time and lower radiation exposure than pre group procedures. Conclusions. A decrease in the FFR was associated with a significant reduction in radiation exposure in AP ablation procedures