Ralph Schneider1, Jörg Lauschke2, Cindy Schneider2, Tina Tischer2, Aenne Glass3, Dietmar Bänsch2. 1. Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany. ralph.schneider@med.uni-rostock.de. 2. Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany. 3. Institute for Biostatistics and Informatics in Medicine, University Rostock, Rostock, Germany.
Abstract
AIMS: Pulmonary vein isolation (PVI) during ablation of atrial fibrillation (Afib) may be associated with long fluoroscopy duration. Although most current publications report on fluoroscopy time (FT), the dose-area product (DAP) may be a more valuable parameter for depicting radiation exposure. The aim of our study was to describe a method to reduce DAP by simple means during ablation of Afib. METHODS:Patients undergoing Afib ablation using a three-dimensional (3D) mapping system were assigned to two fluoroscopy protocols: (1) standard settings with 7.5 pictures/s and collimation to the heart, fluoroscopy as needed for the convenience of the operator (standard group, SG); and (2) strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal orientation by the 3D mapping system (redDAP group). The primary endpoint was DAP. RESULTS: The study comprised 206 patients, who were assigned to the SG (n = 101, 49 %) or to theredDAP group (n = 105, 51 %). Mean FT was significantly reduced from 29.9 ± 11.3 min (SG) to 13.3 ± 8.3 min (redDAP group); mean DAP was reduced by approximately 90 % from 8,690 ± 5,727 to 837 ± 647 cGycm(2). The groups did not differ significantly in body mass index (28.8 ± 4.1 vs. 29.0 ± 5.0). PVI could be achieved in 98 of 101 patients (97 %) from the SG group and in all patients (100 %) from the redDAP group. Procedure time was significantly longer in the redDAP group (160.9 ± 35.7 vs. 138.1 ± 34.3 min). CONCLUSION: Radiation exposure during Afib ablation procedures can be reduced with simple means by strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal 3D orientation.
RCT Entities:
AIMS: Pulmonary vein isolation (PVI) during ablation of atrial fibrillation (Afib) may be associated with long fluoroscopy duration. Although most current publications report on fluoroscopy time (FT), the dose-area product (DAP) may be a more valuable parameter for depicting radiation exposure. The aim of our study was to describe a method to reduce DAP by simple means during ablation of Afib. METHODS:Patients undergoing Afib ablation using a three-dimensional (3D) mapping system were assigned to two fluoroscopy protocols: (1) standard settings with 7.5 pictures/s and collimation to the heart, fluoroscopy as needed for the convenience of the operator (standard group, SG); and (2) strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal orientation by the 3D mapping system (redDAP group). The primary endpoint was DAP. RESULTS: The study comprised 206 patients, who were assigned to the SG (n = 101, 49 %) or to the redDAP group (n = 105, 51 %). Mean FT was significantly reduced from 29.9 ± 11.3 min (SG) to 13.3 ± 8.3 min (redDAP group); mean DAP was reduced by approximately 90 % from 8,690 ± 5,727 to 837 ± 647 cGycm(2). The groups did not differ significantly in body mass index (28.8 ± 4.1 vs. 29.0 ± 5.0). PVI could be achieved in 98 of 101 patients (97 %) from the SG group and in all patients (100 %) from the redDAP group. Procedure time was significantly longer in the redDAP group (160.9 ± 35.7 vs. 138.1 ± 34.3 min). CONCLUSION: Radiation exposure during Afib ablation procedures can be reduced with simple means by strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal 3D orientation.
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