Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Jun 2018)

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

DOI
https://doi.org/10.1161/JAHA.117.008233
Journal volume & issue
Vol. 7, no. 11

Abstract

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BackgroundOnly 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 ResultsWe 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). ConclusionsElectrophysiological 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.

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