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Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children’s hospital.

Methods

All patients that underwent EP and ablation procedures between January 2012 and August 2015 were included; demographic information, fluoroscopy time (FT), total radiation dose (RAD), and dose-area product (DAP) were collected. Patients were stratified by time period (before vs. after C3 introduction) in three groups: (1) normal heart, (2) congenital heart disease (CHD), and (3) those requiring trans-septal (TS) access. The normal heart group was further separated by arrhythmia diagnosis (accessory pathway (AP), AV nodal reentry tachycardia (AVNRT), atrial, or ventricular arrhythmia). Mean values were compared using a single sample t test, as well as analysis of covariance to control for age, weight, and arrhythmia diagnosis.

Results

Mean FT decreased after introduction of C3 in patients in all three patient groups (p < 0.01). When separated by arrhythmia diagnosis, FT decreased in the AP and AVNRT groups (p < 0.0001). After controlling for age, weight, and arrhythmia diagnosis, there was a statistically significant decrease in FT in all three groups and in both RAD and DAP in the normal heart group. Zero fluoroscopy was achieved in 50/159 (31 %) and ≤1 min of FT in 71/159 (45 %) of cases.

Conclusions

We have shown a significant decrease in multiple measures of radiation after introduction of C3. Continued refinements are needed to further decrease radiation utilization and achieve the goal of zero fluoroscopy.

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References

  1. Andreassi, M. G., Ait-Ali, L., Botto, N., Manfredi, S., Mottola, G., & Picano, E. (2006). Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease. European Heart Journal, 27(22), 2703–2708.

    Article  PubMed  Google Scholar 

  2. Gerber, T. C., Carr, J. J., Arai, A. E., Dixon, R. L., Ferrari, V. A., Gomes, A. S., et al. (2009). Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation, 119(7), 1056–1065.

    Article  PubMed  Google Scholar 

  3. Drago, F., Silvetti, M. S., Di Pino, A., Grutter, G., Bevilacqua, M., & Leibovich, S. (2002). Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. Journal of Cardiovascular Electrophysiology, 13(8), 778–782.

    Article  PubMed  Google Scholar 

  4. Kerst, G., Parade, U., Weig, H. J., Hofbeck, M., Gawaz, M., & Schreieck, J. (2012). A novel technique for zero-fluoroscopy catheter ablation used to manage Wolff-Parkinson-White syndrome with a left-sided accessory pathway. Pediatric Cardiology, 33(5), 820–823.

    Article  PubMed  Google Scholar 

  5. Kwong, W., Neilson, A. L., Chiu, C. C., Gross, G. J., Hamilton, R. M., Soucie, L., et al. (2012). The effect of NavX on fluoroscopy times in pediatric catheter ablation. Journal of Interventional Cardiac Electrophysiology, 33(1), 123–126.

    Article  PubMed  Google Scholar 

  6. Miyake, C. Y., Mah, D. Y., Atallah, J., Oikle, H. P., Melgar, M. L., Alexander, M. E., et al. (2011). Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm, 8(4), 519–525.

    Article  PubMed  Google Scholar 

  7. Ozyilmaz, I., Ergul, Y., Akdeniz, C., Ozturk, E., Tanidir, I. C., & Tuzcu, V. (2014). Catheter ablation of idiopathic ventricular tachycardia in children using the EnSite NavX system with/without fluoroscopy. Cardiology in the Young, 24(5), 886–892.

    Article  PubMed  Google Scholar 

  8. Smith, G., & Clark, J. M. (2007). Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing and Clinical Electrophysiology, 30(4), 510–518.

    Article  PubMed  Google Scholar 

  9. Tuzcu, V. (2012). Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single center. Pacing and Clinical Electrophysiology, 35(9), 1067–1073.

    Article  PubMed  Google Scholar 

  10. Wan, G., Shannon, K. M., & Moore, J. P. (2012). Factors associated with fluoroscopy exposure during pediatric catheter ablation utilizing electroanatomical mapping. Journal of Interventional Cardiac Electrophysiology, 35(2), 235–242.

    Article  PubMed  Google Scholar 

  11. Mullins, C. E. (2006). Cardiac catheterization in congenital heart disease: pediatric and adult. Massachusetts: Blackwell Futura.

    Google Scholar 

  12. Pass, R. H., Gates, G. G., Gellis, L. A., Nappo, L., & Ceresnak, S. R. (2014). Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO(R) 3 in concert with “ALARA” principles profoundly lowers total dose. Cardiol Young, 1–6.

  13. Spar, D. S., Anderson, J. B., Lemen, L., Czosek, R. J., & Knilans, T. K. (2013). Consequence of use of lower dose flat plate fluoroscopy in pediatric patients undergoing ablation for supraventricular tachycardia. American Journal of Cardiology, 112(1), 85–89.

    Article  PubMed  Google Scholar 

  14. Ghelani, S. J., Glatz, A. C., David, S., Leahy, R., Hirsch, R., Armsby, L. B., et al. (2014). Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC. Cardiovascular Interventions, 7(9), 1060–1069.

    Article  PubMed  Google Scholar 

  15. Kean, A. C., LaPage, M. J., Yu, S., Dick, M., 2nd, & Bradley, D. J. (2014). Patient and Procedural Correlates of Fluoroscopy Use During Catheter Ablation in the Pediatric and Congenital Electrophysiology Lab. Congenital Heart Disease.

  16. Clark, J., Bockoven, J. R., Lane, J., Patel, C. R., & Smith, G. (2008). Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing and Clinical Electrophysiology, 31(3), 283–289.

    Article  PubMed  Google Scholar 

  17. Esch, J. J., Triedman, J. K., Cecchin, F., Alexander, M. E., & Walsh, E. P. (2013). Radiofrequency-assisted transseptal perforation for electrophysiology procedures in children and adults with repaired congenital heart disease. Pacing and Clinical Electrophysiology, 36(5), 607–611.

    Article  PubMed  Google Scholar 

  18. Pavlovic, N., Reichlin, T., Kuhne, M., Knecht, S., Osswald, S., & Sticherling, C. (2014). Fluoroscopy-free recrossing of the interatrial septum during left atrial ablation procedures. Journal of Interventional Cardiac Electrophysiology, 41(3), 261–266.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank both Dalal Al-Kandari and Hana Jafar (Kuwait University Faculty of Medicine) for their assistance in obtaining important data that was vital to the completion of our manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Children’s National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA

    Bradley C. Clark, Kohei Sumihara, Charles I. Berul & Jeffrey P. Moak

  2. Division of Biostatistics and Informatics, Children’s National Health System, Washington, DC, 20010, USA

    Robert McCarter

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  1. Bradley C. Clark
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  2. Kohei Sumihara
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  3. Robert McCarter
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  4. Charles I. Berul
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Correspondence to Bradley C. Clark.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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For this type of study, formal consent was not required, but the study was approved by the Institutional Review Board at Children’s National Health System.

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Clark, B.C., Sumihara, K., McCarter, R. et al. Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation. J Interv Card Electrophysiol 46, 183–189 (2016). https://doi.org/10.1007/s10840-016-0099-4

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  • DOI: https://doi.org/10.1007/s10840-016-0099-4

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