The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

Abstract

Standard imaging during electrophysiological procedures (EPs) uses fluoroscopy. The aim of this study was to evaluate the feasibility, efficacy, safety and effect of an extended use of non-fluoroscopic mapping systems (NMSs) for imaging during paediatric EPs in an adult EP laboratory focusing on the amount of X-ray exposure. This study is a retrospective analysis that includes consecutive young patients (83 pts, aged between 8 and 18) who underwent EPs from March 2005 to February 2015. We compare the fluoroscopy data of two groups of pts: Group I, pts who underwent EPs from 2005 to 2008 using only fluoroscopy and Group II, pts who underwent EPs from 2008 to 2015 performed also using NMSs. The use of an NMS resulted in reduced fluoroscopy time in Group II {median value 0.1 min (95 % CI [0.00-1.07])} compared to Group I {median value 3.55 min (95 % CI [1.93-7.83]) (MW test, P < 0.05)}. There was a complementary reduction in the total X-ray exposure from 2.53 Gy cm(2) (95 % CI [1.51-4.66]) in Group I to 0.05 Gy cm(2) in Group II (95 % CI [0.00-1.22]) (MW test, P < 0.05). Regarding ablation procedures, the median effective dose decreased from 3.04 mSv (95 % CI [1.22-6.89]) to 0.25 mSv (95 % CI [0.00-0.60]) (MW test, P < 0.05). The use of an NMS dramatically reduces fluoroscopy time and total X-ray exposure during EPs in children and teenagers in an adult EP laboratory. In our experience, this reduction is mainly related to the systematic day-to-day use of NMSs.

Is the systematic use of mapping systems during His Bundle catheter ablation cost‐effective? A single‐center experience

“…The significant reduction in fluoroscopy exposure was an unexpected effect of this use, and this advantage has been validated in several papers based on randomized 21,22 and nonrandomized studies in adults 23,24 and pediatric populations 25 . However, the effect of the regular use of an NMS during HB‐CA procedures has not been investigated in terms of efficacy, safety, and economic advantages.…”

“…In our previous paper, we analyzed these aspects in adults 8,9 and children 25 and our final conclusions were as follows: first, the use of NMS enables fluoroscopy exposure to be considerably reduced; second, the economic advantage depends on the specific situation of the EP Laboratory and is directly related to the amount of the effective dose reduction.…”

An Economic Analysis of the Systematic Use of Mapping Systems during Catheter Ablation Procedures: Single Center Experience

“…Nowadays the efficacy of the use of NMSs for the treatment of complex and simple arrhythmias has been well-demonstrated [22, 23]. An unexpected effect of this use is a significant reduction in fluoroscopy exposure and this advantage was validated in several papers based on randomized [9, 24, 25] and nonrandomized studies in adults [10, 26, 27] and paediatric populations [28]. However, regular use of an NMS during CA procedures is not enough to achieve the reduction in X-ray exposure; in fact, in our opinion a change in the mindset of the operators is fundamental in order to accomplish this reduction [12].…”