Thomas Kleemann1, Johannes Brachmann2, Thorsten Lewalter3, Dietrich Andresen4, Stephan Willems5, Stefan G Spitzer6, Ellen Hoffmann7, Lars Eckardt8, Matthias Hochadel9, Jochen Senges9, Karl-Heinz Kuck10, Karlheinz Seidl11, Ralf Zahn12. 1. Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany. kleemann.thomas@web.de. 2. Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany. 3. Peter Osypka Herzzentrum München, Internistische Klinik Dr. Müller, München-Thalkirchen, Munich, Germany. 4. Department of Cardiology and Internal Medicine, Vivantes Klinikum Am Urban, Berlin, Germany. 5. Department of Electrophysiology, University Heart Centre Hamburg, Hamburg, Germany. 6. Praxisklinik Herz und Gefäße, Dresden, Germany. 7. Klinik für Kardiologie und Internistische Intensivmedizin, Krankenhaus München Bogenhausen, Munich, Germany. 8. Division of Electrophysiology, Department of Cardiology and Angiology, University of Münster, Münster, Germany. 9. Stiftung Institute for Myocardial Infarction, Ludwigshafen, Germany. 10. Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany. 11. Medizinische Klinik I, Klinikum Ingolstadt, Ingolstadt, Germany. 12. Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany.
Abstract
AIM: The aim of this study was to analyze the radiation usage in patients undergoing pulmonary vein isolation (PVI) in Germany and to evaluate the possibility to reduce radiation dose. METHODS AND RESULTS: A total of 6617 patients with atrial fibrillation (AF) from the German ablation registry and the FREEZEplus registry (control group), who underwent first PVI between 2007 and 2014, were analyzed. In the second step, the effect of optimized conventional fluoroscopy and optimized 3D mapping use was evaluated in 526 consecutive patients with AF who underwent first PVI at the Klinikum Ludwigshafen (optimized group) between 2007 and 2014. In the control group, the median dose area product (DAP) for PVI was 34 Gy cm(2), and the median DAP rate was 1.3 Gy cm(2)/min. The DAP decreased from 37 to 28 Gy cm(2), whereas the DAP rate increased from 1.3 to 1.6 Gy cm(2)/min between 2007 and 2014. In the optimized group, optimized radiation application and use of 3D mapping resulted in a continuous decrease in the DAP from 67 to 2 Gy cm(2) and DAP rate from 1.0 to 0.2 Gy cm(2)/min. CONCLUSION: Currently, the median radiation exposure during PVI in Germany is 28 Gy cm(2). Optimized fluoroscopy by simple means can safely reduce the radiation dose to about 2 Gy cm(2) or even lower when using 3D mapping. Before introducing novel expensive technologies for radiation reduction optimizing of the conventional fluoroscopy is mandatory.
AIM: The aim of this study was to analyze the radiation usage in patients undergoing pulmonary vein isolation (PVI) in Germany and to evaluate the possibility to reduce radiation dose. METHODS AND RESULTS: A total of 6617 patients with atrial fibrillation (AF) from the German ablation registry and the FREEZEplus registry (control group), who underwent first PVI between 2007 and 2014, were analyzed. In the second step, the effect of optimized conventional fluoroscopy and optimized 3D mapping use was evaluated in 526 consecutive patients with AF who underwent first PVI at the Klinikum Ludwigshafen (optimized group) between 2007 and 2014. In the control group, the median dose area product (DAP) for PVI was 34 Gy cm(2), and the median DAP rate was 1.3 Gy cm(2)/min. The DAP decreased from 37 to 28 Gy cm(2), whereas the DAP rate increased from 1.3 to 1.6 Gy cm(2)/min between 2007 and 2014. In the optimized group, optimized radiation application and use of 3D mapping resulted in a continuous decrease in the DAP from 67 to 2 Gy cm(2) and DAP rate from 1.0 to 0.2 Gy cm(2)/min. CONCLUSION: Currently, the median radiation exposure during PVI in Germany is 28 Gy cm(2). Optimized fluoroscopy by simple means can safely reduce the radiation dose to about 2 Gy cm(2) or even lower when using 3D mapping. Before introducing novel expensive technologies for radiation reduction optimizing of the conventional fluoroscopy is mandatory.
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