TY - JOUR
T1 - X-ray exposure in cardiac electrophysiology
T2 - A retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory
AU - Casella, Michela
AU - Russo, Antonio Dello
AU - Russo, Eleonora
AU - Catto, Valentina
AU - Pizzamiglio, Francesca
AU - Zucchetti, Martina
AU - Majocchi, Benedetta
AU - Riva, Stefania
AU - Vettor, Giulia
AU - Dessanai, Maria Antonietta
AU - Fassini, Gaetano
AU - Moltrasio, Massimo
AU - Tundo, Fabrizio
AU - Vignati, Carlo
AU - Conti, Sergio
AU - Bonomi, Alice
AU - Carbucicchio, Corrado
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Tondo, Claudio
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.
AB - Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.
KW - Atrial fibrillation
KW - Catheter ablation
KW - X-ray
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U2 - 10.1161/JAHA.117.008233
DO - 10.1161/JAHA.117.008233
M3 - Article
C2 - 29789334
AN - SCOPUS:85048007909
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e008233
ER -