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Improving Safety in the Electrophysiology Laboratory Using a Simple Radiation Dose Reduction Strategy: A Study of 1007 Radiofrequency Ablation Procedures
Study Questions:
How effectively do radiation dose-reduction maneuvers (RDRMs) decrease radiation exposure in the electrophysiology laboratory?
Methods:
Radiation doses were measured in a biplane electrophysiology laboratory during ablation procedures before and after implementation of RDRMs in 297 and 710 patients, respectively. The RDRMs consisted of removing a secondary radiation grid intended to improve image quality and reducing the fluoroscopy pulse rate from 12.5 to 6.25 pulses/second. A non-fluoroscopic three-dimensional mapping system was used for complex ablation cases. The skin entrance dose rate was measured in vitro using an anthropomorphic phantom. Lifetime risk of malignancy was estimated using published data.
Results:
The RDRMs resulted in a 60-65% reduction in the skin entrance radiation dose rate in all projections. The mean fluoroscopy times were approximately 20 minutes for simple ablation procedures (e.g., slow pathway ablation) and 50-55 minutes for complex ablation procedures (e.g., atrial fibrillation) both before and after implementation of the RDRMs. Radiation exposure was reduced from a mean of 20.4-8.0 Gycm2 for simple ablation procedures and from a mean of 63.3 to 32.8 Gycm2 for complex ablation procedures. The excess lifetime risk of fatal malignancy was reduced by 63-65% after implementation of the RDRMs.
Conclusions:
A simple radiation dose-reduction strategy decreases radiation exposure during ablation procedures, lowering the risk of radiation-related fatal malignancy by 63-65%.
Perspective:
Radiation exposure in the electrophysiology laboratory can be reduced to an even greater degree by reducing the pulse rate to 3 pulses/second, which this reviewer has found to be adequate, and by relying on the three-dimensional mapping system instead of fluoroscopy during simple catheter manipulations.
Keywords: Electrophysiology, Fluoroscopy, Catheter Ablation, Radiation Dosage, England
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