X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory

Michela Casella, Antonio Dello Russo, Eleonora Russo, Valentina Catto, Francesca Pizzamiglio, Martina Zucchetti, Benedetta Majocchi, Stefania Riva, Giulia Vettor, Maria Antonietta Dessanai, Gaetano Fassini, Massimo Moltrasio, Fabrizio Tundo, Carlo Vignati, Sergio Conti, Alice Bonomi, Corrado Carbucicchio, Luigi Di Biase, Andrea Natale, Claudio Tondo, Michela Casella, Antonio Dello Russo, Eleonora Russo, Valentina Catto, Francesca Pizzamiglio, Martina Zucchetti, Benedetta Majocchi, Stefania Riva, Giulia Vettor, Maria Antonietta Dessanai, Gaetano Fassini, Massimo Moltrasio, Fabrizio Tundo, Carlo Vignati, Sergio Conti, Alice Bonomi, Corrado Carbucicchio, Luigi Di Biase, Andrea Natale, Claudio Tondo

Abstract

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.

Keywords: atrial fibrillation; catheter ablation; x‐ray.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Fluoroscopy exposure trend per operator over time. All 7 experienced operators, over time, significantly decreased fluoroscopy time (A) and patient's dose exposure (B) during AF ablation procedures. AF indicates atrial fibrillation; DAP, dose area product; OP, operator.
Figure 2
Figure 2
Comparison of fluoroscopy time and DAP between mRFCA and Cryo over time. A, Reduction of fluoroscopy time associated with mRFCA (Δ = −56%) and Cryo (Δ = −67%) procedures over time. There is no difference between the 2 techniques. B, The radiation dose reduction associated with mRFCA procedure (Δ = −78%) and Cryo (Δ = −80%) procedure over time. Considering the 7‐year interval, DAP values were significantly different between the 2 techniques (P = 0.006). If we consider only the past 2 years, DAP values were similar between the 2 techniques (P=ns). Cryo indicates cryoablation; DAP, dose area product; mRFCA, manual radiofrequency catheter ablation.

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