scholarly journals RADIATION EXPOSURE IN ACCESSORY PATHWAY ABLATION PROCEDURES IN CARDIAC ELECTROPHYSIOLOGY: A RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 7 (1) ◽  
pp. 28-34
Author(s):  
M. Ali ◽  
B. Banavalikar ◽  
M. K. Ghadei ◽  
A. Kottayan ◽  
D. Padmanabhan ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cardiac Electrophysiology ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Frame Rate ◽  
Procedure Time ◽  
Dose Area Product ◽  
Electroanatomic Mapping System ◽  
Common Location ◽  
The Impact

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

Fluoroscopy time is not accurate as a surrogate for radiation exposure

Vascular ◽  
2017 ◽  
Vol 25 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Edvard Skripochnik ◽  
Shang A Loh
Keyword(s):  
Radiation Exposure ◽  
Medical Center ◽  
Pearson Correlation ◽  
Academic Medical Center ◽  
Surrogate Marker ◽  
Correlation Coefficients ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Poor Correlation ◽  
Dose Area Product

Objective The Food and Drug Administration and the Vascular Quality Initiative still utilize fluoroscopy time as a surrogate marker for procedural radiation exposure. This study demonstrates that fluoroscopy time does not accurately represent radiation exposure and that dose area product and air kerma are more appropriate measures. Methods Lower extremity endovascular interventions ( N = 145) between 2013 and 2015 performed at an academic medical center on a Siemens Artis-Zee floor mounted c-arm were identified. Data was collected from the summary sheet after every case. Scatter plots with Pearson correlation coefficients were created. A strong correlation was indicated by an r value approaching 1. Results Overall mean AK and DAP was 380.27 mGy and 4919.2 µGym2. There was a poor correlation between fluoroscopy time and total AK or DAP ( r = 0.27 and 0.32). Total DAP was strongly correlated to cine DAP and fluoroscopy DAP ( r = 0.92 vs. 0.84). The number of DSA runs and average frame rate did not affect AK or DAP levels. Mean magnification level was significantly correlated with total AK ( r = 0.53). Conclusions Fluoroscopy time shows minimal correlation with radiation delivered and therefore is a poor surrogate for radiation exposure during fluoroscopy procedures. DAP and AK are more suitable markers to accurately gauge radiation exposure.

P6551Evaluation of a new ultra low-dose radiation protocol during electrophysiological device implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Eichenlaub ◽  
K Astheimer ◽  
C Restle ◽  
C Maring ◽  
T Blum ◽  
...  
Keyword(s):  
Low Dose ◽  
De Novo ◽  
Cardiac Resynchronisation Therapy ◽  
Radiation Doses ◽  
Procedure Time ◽  
Low Dose Radiation ◽  
Dose Area Product ◽  
Device Implantation ◽  
The Impact ◽  
Dose Radiation

Abstract Objectives The aim of this study was to evaluate the impact of a new ultra low-dose radiation protocol on radiation doses, feasibility and safety during electrophysiological device implantation. Background Radiation is one of the main hazards during electrophysiological procedures. Shielding is especially difficult during device implantation and particularly implantation of cardiac resynchronisation therapy devices (CRT) is associated with high radiation doses. Methods From January 2005 to January 2019, 8612 patients underwent de novo device implantation at our University Heart Center. During 2018, we established a new ultra low-dose radiation protocol and compared 661 patients who were treated during 2017 utilizing the conventional low-dose protocol with 512 patients after the application of the new program (11.5% one-chamber devices, 68.5% two-chamber devices and 19.9% CRT). Results After establishment of the radiation reduction protocol, dose area products could be reduced by 62% and the effective doses by 59% (113 (47–292) vs. 43 (14–130) cGycm2, p<0.0001 and 0.25 (0.11–0.63) vs. 0.10 (0.03–0.28) mSv, p<0.0001). These results could be achieved without prolonging procedure time, increasing complication and decreasing success rate. Male gender, higher BMI, longer procedure and fluoroscopy duration and the use of the conventional radiation protocol were statistically significant factors for the need of higher radiation doses in multivariate regression analysis. Clinical and procedural characteristics All (n=1173) Group pre (n=661) Group post (n=512) P Age, years 77 (69–82) 77 (69–82) 77 (69–83) 0.6 Male, n (%) 726 (62) 403 (61) 323 (63) 0.5 Body mass index, kg/m2 26.6 (24–29.8) 26.6 (24–29.8) 26.4 (24–29.4) 0.5 Procedure time, minutes 35 (25–50) 37 (26–50) 35 (25–54.5) 0.5 Fluoroscopy time, minutes 3.7 (2–7.8) 4 (2–7.8) 3.4 (1.9–7.7) 0.07 Dose area product, cGy cm2 80 (28–228) 113 (47–292) 43 (14–130) <0.0001 Effective dose, mSv 0.18 (0.06–0.51) 0.25 (0.11–0.63) 0.1 (0.03–0.28) <0.0001 Complications, n (%) 11 (0.9) 7 (1.1) 4 (0.8) 0.8 Conclusions Radiation exposure during electrophysiological device implantation has been continuously reduced over the last years. By establishing a new ultra low-dose radiation protocol, we could further decrease the radiation dose significantly and reach the lowest radiation values published so far. This protocol can easily be implemented in the workflow of other hospitals and should become standard during implantation procedures.

scholarly journals The Impact of Implementing a Radiation-Sparing Protocol for Percutaneous Kyphoplasty—A Prospective Dosemetric Study

2021 ◽  
pp. 219256822110394
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Roland Roelz ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Rating Scale ◽  
Detection Limits ◽  
Numeric Rating Scale ◽  
Prospective Clinical Study ◽  
Intraoperative Radiation ◽  
Dose Area Product ◽  
Occupational Dose ◽  
Lower Detection ◽  
The Impact

Study Design: Prospective cohort study. Objectives: The purpose of this prospective study was to evaluate a protocol for radiation-sparing kyphoplasty by assessing dosemetrically recorded radiation exposures to both patient and surgeon. Methods: This prospective clinical study examines the radiation exposure to patient and surgeon during single-level kyphoplasty in 32 thoracolumbar osteoporotic vertebral body fractures (12 OF 2, 9 OF 3, 11 OF 4 types) using a radiation aware surgical protocol between May 2017 and November 2019. The radiation exposure was measured at different locations using film, eye lens and ring dosemeters. Dose values are reported under consideration of lower detection limits of each dosemeter type. Results: A high proportion of dosemeter readings was below the lower detection limits, especially for the surgeon (>90%). Radiation exposure to the surgeon was highest at the unprotected thyroid gland (0.053 ± 0.047 mSv), however only slightly above the lower detection limit of dosemeters (0.044 mSv). Radiation exposure to the patient was highest at the chest (0.349 ± 0.414 mSv) and the gonad (0.186 ± 0.262 mSv). Fluoroscopy time, dose area product and number of fluoroscopic images were 46.0 ± 17.9 sec, 124 ± 109 cGy×cm2, and 35 ± 13 per kyphoplasty, respectively. Back pain significantly improved from 6.8 ± 1.6 to 2.5 ± 1.7 on the numeric rating scale on the first postoperative day ( P < 0.0001). Conclusions: The implementation of a strict intraoperative radiation protection protocol allows for safely performed kyphoplasty with ultra-low radiation exposure for the patient and surgeon without exceeding the annual occupational dose limits. Trial registration: The study was registered in the German Clinical Trials Register (DRKS00011908, registration date 16/05/2017).

Efficacy, Time, Cost and Radiation Exposure of Combined Limited Fluoroscopy with Non-fluoroscopic Three-dimensional Imaging in Paediatric Supraventricular Tachycardia Ablation – Best of Both Worlds

2015 ◽  
Vol 01 (01) ◽  
pp. 27 ◽  
Author(s):  
Yamuna Sanil ◽  
Harinder R Singh ◽  
Paul A Webster ◽  
Peter P Karpawich ◽  
◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Three Dimensional ◽  
Success Rates ◽  
Three Dimensional Imaging ◽  
Dose Area Product ◽  
Ablation Success ◽  
Fluoroscopic Imaging ◽  
Procedural Success ◽  
Sustained Success ◽  
Area Product

Objective: Catheter ablation for supraventricular tachycardias (SVTs) traditionally has utilised fluoroscopic imaging (FI). However, radiation concerns have recently contributed to the evolution of non-fluoroscopic three-dimensional imaging (3DI) systems. A few recent studies have advocated non-FI in lieu of FI. To date, there are only a few studies reporting use of limited FI with 3DI usage in children undergoing SVT ablations. This study evaluates time, efficacy, cost and safety of limited FI plus 3DI for SVT ablation in the young.Methods: Electrophysiology study (EPS) and ablation data for standard forms of SVT from October 2009 to June 2012 were reviewed. Patient radiation time, radiation dose area product (DAP), EPS time, anaesthesia duration and cost, and ablation success rates were evaluated.Results: A total of 81 patients (mean age 13.2 ± 3.4 years) underwent ablation. Type of SVT, gender, age, acute success, adverse events and recurrences were recorded post-ablation for over 2.5 years. Acute procedural success was 93.8 %. Of these, chronic sustained success was 85.5 %. As expected, limited FI plus 3DI was associated with some radiation exposure (2.47 ± 2.78 milliGray-m2) but less than historically associated with paediatric tachycardia ablations.Conclusion: A conscious awareness to use limited FI combined with 3DI is associated with excellent long-term success, lack of complications and marked decrease in radiation exposure. Although 3DI-only has some appeal, use of combined limited radiation is associated with some advantages overall. Potential adverse effects of limited radiation need to be weighed in when deciding which imaging or combination to use.

scholarly journals Noninvasive localization of cardiac arrhythmias using electromechanical wave imaging

2020 ◽  
Vol 12 (536) ◽  
pp. eaax6111
Author(s):  
Christopher S. Grubb ◽  
Lea Melki ◽  
Daniel Y. Wang ◽  
James Peacock ◽  
Jose Dizon ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Frame Rate ◽  
Clinical Tool ◽  
Ultrasound Technique ◽  
Cardiac Model ◽  
Wave Imaging ◽  
Double Blinded

Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high–frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.

scholarly journals Fluoroless cryo-ablation of para-Hisian accessory pathway

2017 ◽  
Vol 86 (3-4) ◽  
Author(s):  
Tine Prolič Kalinšek ◽  
Matevž Jan ◽  
Borut Geršak ◽  
Jure Jug
Keyword(s):  
Radiation Exposure ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Conduction System ◽  
Collateral Damage ◽  
White Syndrome ◽  
Mapping System ◽  
Cryo Ablation ◽  
Wolff Parkinson White Syndrome

We present a case of para-Hisian accessory pathway ablation in a patient with Wolff-Parkinson-White syndrome, which was performed with cryoablation to reduce the possibility of collateral damage to the conduction system of the heart. We also used fluoroless approach to exclude possible harm from radiation exposure, using only intracardial electrograms and three-dimensional (3D) electro-anatomic mapping system to navigate the catheters in the heart.

Abstract 17014: Getting to Zero: Impact of Electroanatomical Mapping on Fluoroscopy Use in Pediatric Catheter Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Bradley C Clark ◽  
Kohei Sumihara ◽  
Robert McCarter ◽  
Charles I Berul ◽  
Jeffrey P Moak
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Imaging Techniques ◽  
Statistical Significance ◽  
Accessory Pathway ◽  
Analysis Of Covariance ◽  
Fluoroscopy Time ◽  
Normal Heart ◽  
Dose Area Product ◽  
Zero Fluoroscopy

Introduction: Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children’s hospital. Methods: All patients that underwent EP and ablation procedures between January 2012 and November 2014 were included; demographic information, fluoroscopy time in minutes (FT), total radiation dose in mGy (RAD), and dose-area product in μGy/m2 (DAP) were collected. Patients were stratified by time period (before vs. after C3 introduction), structural group (normal heart, congenital heart disease (CHD), and those with normal cardiac anatomy requiring trans-septal (TS) access), and arrhythmia diagnosis (Accessory Pathway (AP), AV Nodal Reentry Tachycardia (AVNRT), atrial, or ventricular arrhythmia). Mean values were compared using a single sample t-test, as well as analysis of covariance to control for age, weight, and arrhythmia diagnosis. Results: Mean FT decreased after the introduction of C3 in patients with normal hearts (p<0.001), AP (p<0.001), AVNRT (p=0.002), and CHD (p=0.007). After controlling for age, weight, and arrhythmia diagnosis, there was a statistically significant decrease in FT in all three groups (normal heart, CHD and TS), in RAD in the TS group, and in DAP in both the normal heart and TS groups. In all other groups, there was a trend towards decreased RAD and DAP, but they did not reach statistical significance. After the introduction of C3, zero fluoroscopy was achieved in 18/66 (27%) and ≤ 1 minute of FT in 28/66 (42%) of ablation procedures in patients with normal hearts. Conclusions: We have shown a decrease in all metrics that measure radiation exposure when comparing the time periods before and after the introduction of C3, secondary to reducing fluoroscopy time, fluoroscopic pulse rate and radiation dose per pulse. Further refinements are still needed to decrease radiation exposure towards the goal of zero fluoroscopy, but this cannot be achieved without thinking beyond fluoroscopy time.

Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Nuri I Akkus ◽  
George S Mina ◽  
Abdulrahman Abdulbaki ◽  
Fereidoon Shafiei ◽  
Neeraj Tandon
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Success Rate ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Peripheral Vascular ◽  
Dose Area Product ◽  
Group A ◽  
Group B ◽  
Area Product

Background Peripheral vascular interventions can be associated with significant radiation exposure to the patient and the operator. Objective In this study, we sought to compare the radiation dose between peripheral vascular interventions using fluoroscopy frame rate of 7.5 frames per second (fps) and those performed at the standard 15 fps and procedural outcomes. Methods We retrospectively collected data from consecutive 87 peripheral vascular interventions performed during 2011 and 2012 from two medical centers. The patients were divided into two groups based on fluoroscopy frame rate; 7.5 fps (group A, n = 44) and 15 fps (group B, n = 43). We compared the demographic, clinical, procedural characteristics/outcomes, and radiation dose between the two groups. Radiation dose was measured as dose area product in micro Gray per meter square. Results Median dose area product was significantly lower in group A (3358, interquartile range (IQR) 2052–7394) when compared to group B (8812, IQR 4944–17,370), p < 0.001 with no change in median fluoroscopy time in minutes (18.7, IQR 11.1–31.5 vs. 15.7, IQR 10.1–24.1), p = 0.156 or success rate (93.2% vs. 95.3%), p > 0.999. Conclusion Using fluoroscopy at the rate of 7.5 fps during peripheral vascular interventions is associated with lower radiation dose compared to the standard 15 fps with comparable success rate without associated increase in the fluoroscopy time or the amount of the contrast used. Therefore, using fluoroscopy at the rate of 7.5 fps should be considered in peripheral vascular interventions.

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