Aleksandr Voskoboinik1, Elana S Kalman2, Yonatan Savicky2, Paul B Sparks3, Joseph B Morton3, Geoffrey Lee3, Peter M Kistler4, Jonathan M Kalman5. 1. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia. 2. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 3. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. 4. Department of Medicine, University of Melbourne, Melbourne, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia. 5. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: Jon.Kalman@mh.org.au.
Abstract
BACKGROUND: Pulmonary vein isolation (PVI) is a well-established treatment of atrial fibrillation (AF), with contact force (CF)-sensing catheters joining 3-dimensional mapping systems and image integration as technological advancements over the last decade. OBJECTIVE: The purpose of this study was to analyze trends in radiation exposure for AF ablation over the last 12 years at our center. METHODS: We reviewed prospectively collected data of 2344 consecutive PVI procedures for either paroxysmal or persistent AF between January 2004 and December 2015. During this period, all cases used 3-dimensional mapping systems, with 8 software and 2 hardware upgrades. Primary endpoints were fluoroscopy time, absorbed dose (Air Kerma in mGy), and effective dose (mSv). RESULTS: In total, 1914 patients underwent initial PVI, and 430 patients underwent redo PVI using radiofrequency energy. Fluoroscopy time, and absorbed and effective doses significantly and progressively decreased over the 12-year period for initial PVI as follows: 2004-2006: 61 ± 27 minutes; 2007-2009: 46 ± 14 minutes, 1365 ± 1369 mGy, 11.3 ± 12.5 mSv; 2010-2012: 31 ± 11, 464 ± 339 mGy, 9.0 ± 10.4 mSv; and 2013-2015: 17 ± 9 minutes, 304 ± 758 mGy, 5.5 ± 6.7 mSv. CF-sensing catheters were used for 357/508 PVI only cases between 2014 and 2015. Fluoroscopy times (11 ± 5 vs 21 ± 8 minutes; P <.001) and absorbed dose (200 ± 524 vs 470 ± 1326 mGy; P = .004) were significantly shorter with this catheter. CONCLUSION: Radiation exposure has dramatically decreased over the last decade for PVI and is related to operator experience, annual case volume, technology evolution, and more recently CF-sensing catheters. This has significant implications for both patient and operator long-term risk.
BACKGROUND: Pulmonary vein isolation (PVI) is a well-established treatment of atrial fibrillation (AF), with contact force (CF)-sensing catheters joining 3-dimensional mapping systems and image integration as technological advancements over the last decade. OBJECTIVE: The purpose of this study was to analyze trends in radiation exposure for AF ablation over the last 12 years at our center. METHODS: We reviewed prospectively collected data of 2344 consecutive PVI procedures for either paroxysmal or persistent AF between January 2004 and December 2015. During this period, all cases used 3-dimensional mapping systems, with 8 software and 2 hardware upgrades. Primary endpoints were fluoroscopy time, absorbed dose (Air Kerma in mGy), and effective dose (mSv). RESULTS: In total, 1914 patients underwent initial PVI, and 430 patients underwent redo PVI using radiofrequency energy. Fluoroscopy time, and absorbed and effective doses significantly and progressively decreased over the 12-year period for initial PVI as follows: 2004-2006: 61 ± 27 minutes; 2007-2009: 46 ± 14 minutes, 1365 ± 1369 mGy, 11.3 ± 12.5 mSv; 2010-2012: 31 ± 11, 464 ± 339 mGy, 9.0 ± 10.4 mSv; and 2013-2015: 17 ± 9 minutes, 304 ± 758 mGy, 5.5 ± 6.7 mSv. CF-sensing catheters were used for 357/508 PVI only cases between 2014 and 2015. Fluoroscopy times (11 ± 5 vs 21 ± 8 minutes; P <.001) and absorbed dose (200 ± 524 vs 470 ± 1326 mGy; P = .004) were significantly shorter with this catheter. CONCLUSION: Radiation exposure has dramatically decreased over the last decade for PVI and is related to operator experience, annual case volume, technology evolution, and more recently CF-sensing catheters. This has significant implications for both patient and operator long-term risk.
Authors: Tina Baykaner; Kenneth K Quadros; Amit Thosani; Babak Yasmeh; Raman Mitra; Emerson Liu; William Belden; Zhigang Liu; Alex Costea; Chad R Brodt; Paul C Zei Journal: Pacing Clin Electrophysiol Date: 2019-12-23 Impact factor: 1.976
Authors: Paul C Zei; Kenneth K Quadros; Paul Clopton; Amit Thosani; John Ferguson; Chad Brodt; Geraldine O'Riordan; Mattheus Ramsis; Raman Mitra; Tina Baykaner Journal: J Innov Card Rhythm Manag Date: 2020-11-15