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Update zum Strahlenschutz bei der Katheterablation von Vorhofflimmern

Update on radiation exposure in catheter ablation of atrial fibrillation

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Zusammenfassung

Die in den letzten Jahren gestiegene Anzahl an Katheterablationen von Vorhofflimmern bedeutet eine potenzielle Zunahme der Strahlenbelastung für die Patienten und das medizinische Personal. Erfreulicherweise steht diesem Trend u. a. die Weiterentwicklung nichtfluoroskopischer Methoden zur Kathetervisualisierung, verbunden mit der konsequenten Reduzierung der Durchleuchtungszeit pro Prozedur, entgegen. Da Röntgenstrahlung jedoch auch im Niedrigdosisbereich ernstzunehmende Schäden verursachen kann, sind im Sinne des ALARA-Prinzips („as low as reasonably achievable“) alle möglichen Maßnahmen zu ergreifen, um die Strahlendosis weiter zu reduzieren. Eine signifikante Rolle spielen hier Dosisreduktionsprotokolle mit Niedrigdosiseinstellungen. Diese beinhalten u. a. die Optimierung der Parameter Bildrate pro Sekunde, Pulsdauer, Detektoreingangsdosis und Strahlenaufhärtung. Dieser Review-Artikel fasst den aktuellen Stand der Technik der nichtfluoroskopischen Katheterdarstellung und der Dosisreduktionsprogramme bei der Katheterablation von Vorhofflimmern zusammen.

Abstract

The rising number of catheter ablations of atrial fibrillation increases radiation exposure for both patients and surgeons. Fortunately, this trend is counteracted by the development of measures to reduce total fluoroscopy time using non-fluoroscopic catheter visualization. Since even low-dose radiation can cause serious injury, all options to reduce radiation burden must be utilized (ALARA, “as low as reasonably achievable”). Dose reduction protocols with low-dose settings, which include reduced framerates, pulse duration, detector entrance dose and increased beam hardening, play a decisive role in this regard. This review provides a state-of-the-art summary of non-fluoroscopic catheter visualization and dose reduction protocols for catheter ablation of atrial fibrillation.

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Authors and Affiliations

  1. Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    Tobias Schreiber, Nora Kähler, Verena Tscholl MD, Patrick Nagel MD, Ulf Landmesser MD, Martin Huemer MD & Philipp Attanasio MD

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  1. Tobias Schreiber
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  2. Nora Kähler
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  3. Verena Tscholl MD
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  6. Martin Huemer MD
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  7. Philipp Attanasio MD
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Correspondence to Tobias Schreiber.

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Interessenkonflikt

T. Schreiber, N. Kähler, V. Tscholl, P. Nagel, U. Landmesser, M. Huemer und P. Attanasio geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Schreiber, T., Kähler, N., Tscholl, V. et al. Update zum Strahlenschutz bei der Katheterablation von Vorhofflimmern. Herzschr Elektrophys 31, 84–90 (2020). https://doi.org/10.1007/s00399-019-00660-z

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