Jedrzej Kosiuk1, Lucas Fiedler2, Sabine Ernst3, David Duncker4, Nikola Pavlović5, Silvia Guarguagli3, Clara Stegmann6, Dawid Miskowiec7, Rodrigue Garcia8, Vincenzo Russo9, Andriy Yakushev10, Nándor Szegedi11, Tom De Potter12. 1. Rhythmology Department, Helios Clinic Koethen, Koethen, Germany. 2. Department of Internal Medicine II, General Hospital Wiener Neustadt, Wiener Neustadt, Austria. 3. Royal Brompton Hospital, London, UK. 4. Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. 5. Department of Cardiology, Univeristy Hospital Center Sestre Milosrdnice, Zagreb, Croatia. 6. Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany. 7. Department of Cardiology, Medical University of Lodz, Lodz, Poland. 8. Rhythmology Department, CHU de Poitiers, Poitiers, France. 9. Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy. 10. Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine. 11. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 12. Cardiovascular Center, OLV Hospital, Aalst, Belgium.
Abstract
BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x-ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required for optimal clinical routine can be identified. METHODS: Centers participating in this Europe-wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. RESULTS: Twenty-five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2 , 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2 , 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2 , 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2 , 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257-2.318, P = .001), in higher-volume center (OR 1.001 per one additional procedure, 95%CI 1.000-1.001, P = .002), with the use of 3D-mapping system (OR 2.622, 95%CI 2.053-3.347, P < .001) and monoplane x-ray system (OR 2.945, 95%CI 2.149-4.037, P < .001). CONCLUSION: Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x-ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required for optimal clinical routine can be identified. METHODS: Centers participating in this Europe-wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. RESULTS: Twenty-five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2 , 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2 , 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2 , 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2 , 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257-2.318, P = .001), in higher-volume center (OR 1.001 per one additional procedure, 95%CI 1.000-1.001, P = .002), with the use of 3D-mapping system (OR 2.622, 95%CI 2.053-3.347, P < .001) and monoplane x-ray system (OR 2.945, 95%CI 2.149-4.037, P < .001). CONCLUSION: Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
Authors: Johanna Müller-Leisse; Henrike Aenne Katrin Hillmann; Christian Veltmann; David Duncker Journal: Herzschrittmacherther Elektrophysiol Date: 2021-05-04
Authors: Federica Troisi; Pietro Guida; Federico Quadrini; Antonio Di Monaco; Nicola Vitulano; Rosa Caruso; Rocco Orfino; Giacomo Cecere; Matteo Anselmino; Massimo Grimaldi Journal: Front Cardiovasc Med Date: 2022-04-28