Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience

  • Severin Wannagat
  • Lena Loehr
  • Sebastian Lask
  • Katharina Völk
  • Tamer Karaköse
  • Cemil Özcelik
  • Andreas Mügge
  • Alexander Wutzler



Catheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels.


From January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator.


Procedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637 ± 611 μGy/m2; beginner 44.1 ± 79.5 μGy/m2, p = 0.002; 1st year fellow 24.3 ± 46.4.5 μGy/m2, p = 0.001; 2nd year fellow 130.3 ± 233.3 μGy/m2, p = 0.003; expert 9.3 ± 37.4 μGy/m2, P < 0.001). Procedure duration, acute success, and complications were not significantly different between the groups.


Our results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.


Catheter ablation Radiation exposure Zero fluoroscopy Operator experience 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and research committee and with the 1964 Helsinki declaration and its later amendments. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Severin Wannagat
    • 1
  • Lena Loehr
    • 1
  • Sebastian Lask
    • 1
  • Katharina Völk
    • 1
  • Tamer Karaköse
    • 2
  • Cemil Özcelik
    • 2
  • Andreas Mügge
    • 1
  • Alexander Wutzler
    • 1
  1. 1.Cardiovascular Centre, St. Josef-HospitalRuhr-University BochumBochumGermany
  2. 2.Department of CardiologyKnappschaftskrankenhaus RecklinghausenRecklinghausenGermany

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