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Reduction of radiation exposure during ablation of atrial fibrillation

Verminderung der Strahlenbelastung bei Ablation wegen Vorhofflimmern

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Abstract

Aims

Pulmonary vein isolation (PVI) during ablation of atrial fibrillation (Afib) may be associated with long fluoroscopy duration. Although most current publications report on fluoroscopy time (FT), the dose–area product (DAP) may be a more valuable parameter for depicting radiation exposure. The aim of our study was to describe a method to reduce DAP by simple means during ablation of Afib.

Methods

Patients undergoing Afib ablation using a three-dimensional (3D) mapping system were assigned to two fluoroscopy protocols: (1) standard settings with 7.5 pictures/s and collimation to the heart, fluoroscopy as needed for the convenience of the operator (standard group, SG); and (2) strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal orientation by the 3D mapping system (redDAP group). The primary endpoint was DAP.

Results

The study comprised 206 patients, who were assigned to the SG (n = 101, 49 %) or to the redDAP group (n = 105, 51 %). Mean FT was significantly reduced from 29.9 ± 11.3 min (SG) to 13.3 ± 8.3 min (redDAP group); mean DAP was reduced by approximately 90 % from 8,690 ± 5,727 to 837 ± 647 cGycm2. The groups did not differ significantly in body mass index (28.8 ± 4.1 vs. 29.0 ± 5.0). PVI could be achieved in 98 of 101 patients (97 %) from the SG group and in all patients (100 %) from the redDAP group. Procedure time was significantly longer in the redDAP group (160.9 ± 35.7 vs. 138.1 ± 34.3 min).

Conclusion

Radiation exposure during Afib ablation procedures can be reduced with simple means by strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal 3D orientation.

Zusammenfassung

Ziel

Die Pulmonalvenenisolation (PVI) bei der Ablation von Vorhofflimmern (VF) kann mit einer langen Durchleuchtungsdauer einhergehen. In den meisten aktuellen Veröffentlichungen wird zwar die Durchleuchtungsdauer angegeben, aber möglicherweise stellt das Dosis-Flächen-Produkt (DFP) einen Parameter von höherer Aussagekraft dar, um die Strahlenbelastung zu erfassen. Ziel der vorliegenden Studie war es, ein Verfahren zur Verminderung des DFP mit einfachen Mitteln bei Ablation von VF zu beschreiben.

Methoden

Patienten, bei denen eine Ablation wegen VF unter Einsatz eines dreidimensionalen (3-D-)Mapping-Systems erfolgte, wurden 2 unterschiedlichen Durchleuchtungsschemata zugeteilt: 1. Standardeinstellungen mit 7,5 Bildern/s und Einblendung auf das Herz, Durchleuchtung nach Erfordernissen des Operateurs (Standardgruppe, SG) und 2. strenge Einblendung auf den linken Vorhof, eine Bildfrequenz von 4 Bildern/s, verkürzte Pulmonalvenenangiographiesequenzen und maximale Orientierung mittels 3-D (redDAP-Gruppe). Primärer Endpunkt war das DFP.

Ergebnisse

Die Studie umfasste 206 Patienten, die der SG (n = 101, 49 %) oder der redDAP-Gruppe zugeteilt wurden (n = 105, 51 %). Die durchschnittliche Durchleuchtungsdauer wurde signifikant von 29,9 ± 11,3 min (SG) auf 13,3 ± 8,3 min (redDAP-Gruppe) reduziert; das durchschnittliche DFP wurde um annähernd 90 % von 8690 ± 5727 auf 837 ± 647 cGycm2 vermindert. Die Gruppen unterschieden sich nicht signifikant beim Body-Mass-Index (28,8 ± 4,1 vs. 29,0 ± 5,0). Die PVI wurde bei 98 von 101 Patienten (97 %) der SG und bei allen Patienten (100 %) der redDAP-Gruppe erzielt. Die Dauer der Prozedur war in der redDAP-Gruppe signifikant länger (160,9 ± 35,7 vs. 138,1 ± 34,3 min).

Schlussfolgerung

Die Strahlenbelastung bei Ablation von VF kann mit einfachen Mitteln durch strenge Einblendung auf den linken Vorhof, eine Bildfrequenz von4 Bildern/s, verkürzte PV-Angiographiesequenzen und maximale 3-D-Orientierung reduziert werden.

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Authors and Affiliations

  1. Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

    Ralph Schneider MD,  Jörg Lauschke MD,  Cindy Schneider MD,  Tina Tischer MD &  Dietmar Bänsch MD

  2. Institute for Biostatistics and Informatics in Medicine, University Rostock, Rostock, Germany

    Aenne Glass

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  1. Ralph Schneider MD
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  2. Jörg Lauschke MD
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Correspondence to Ralph Schneider MD.

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Conflict of interest

R. Schneider, J. Lauschke, C. Schneider, T. Tischer, A. Glass, and D. Bänsch state that there are no conflicts of interest.

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R. Schneider and J. Lauschke contributed equally to this article.

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Schneider, R., Lauschke, J., Schneider, C. et al. Reduction of radiation exposure during ablation of atrial fibrillation. Herz 40, 883–891 (2015). https://doi.org/10.1007/s00059-015-4307-2

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