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Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: a prospective study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Pulmonary vein antral isolation (PVAI) is an effective treatment for atrial fibrillation and involves prolonged procedure and fluoroscopy times. This study assesses the impact of a comprehensive radiation safety program on patient and operator radiation exposure during PVAI.

Methods and Results

We evaluated a comprehensive radiation safety program including: (1) verbal reinforcement of previous fluoroscopy times (2) effective collimation (3) minimizing source-intensifier distance and (4) effective lead shield use. Exposure doses in 41 consecutive patients without (group-I, n = 21) and with (group-II, n = 20) the use of radiation safety program were assessed. PVAI was done using intracardiac echo (ICE) guided roving circular mapping catheter. A 3-dimensional mapping system was used in 27% cases for additional guidance. Operator and patient exposure was measured during the PVAI. The age, gender, body mass index and AF duration were similar in both of the groups. The total procedure (166 ± 56 vs 178 ± 38 min, p = 0.54) and fluoroscopy times (74 ± 24 vs 70 ± 20 min, p = 0.72) were comparable. Group-II had significantly lower dose area product (234 ± 120 vs 548 ± 363 Gy cm2, p = 0.03) compared to group-I. The mean operator exposure was reduced by half and mean patient peak skin dose by three to ten times with comprehensive radiation safety program. None of the patients were noted to have radiation related skin injuries. Additional lifetime cancer risk was significantly lower in group-II patients (0.08 vs 0.2%, p < 0.001) than group-I.

Conclusions

Implementation of a comprehensive radiation safety program described above significantly decreases the radiation exposure to the patient as well as the operator.

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Acknowledgement

We thank Ronald Leuenberger Ph.D. from Cleveland Clinic for his critical review of this manuscript. We are sorry to inform that George Nadzam MS, has passed since the study was completed.

Conflicts of interest

There are no conflicts of interests for any of the authors relevant to the study.

Author information

Authors and Affiliations

  1. Mid America Cardiology, University of Kansas Hospital, Kansas City, KS, USA

    Dhanunjaya Lakkireddy

  2. Cleveland Clinic Foundation, Cleveland, OH, USA

    George Nadzam

  3. Southlake Regional Hospital, New Market, ON, Canada

    Atul Verma

  4. Cardiovascular Associates, Elk Grove Village, IL, USA

    Mohammed Khan

  5. Akron General Hospital, Akron, OH, USA

    Robert Schweikert

  6. Texas Cardiac Arrhythmia Institute, St. David Medical Center, 7165 Ridge Oak Rd, Austin, TX, 78705, USA

    Luigi Di Biase, David Burkhardt & Andrea Natale

  7. Stanford University, Palo Alto, CA, USA

    Andrea Natale

  8. Case Western Reserve University, Cleveland, OH, USA

    Andrea Natale

Authors
  1. Dhanunjaya Lakkireddy
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  2. George Nadzam
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  3. Atul Verma
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  4. Subramanya Prasad
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  5. Kay Ryschon
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  6. Luigi Di Biase
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  7. Mohammed Khan
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  8. David Burkhardt
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  9. Robert Schweikert
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  10. Andrea Natale
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Corresponding author

Correspondence to Andrea Natale.

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Lakkireddy, D., Nadzam, G., Verma, A. et al. Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: a prospective study. J Interv Card Electrophysiol 24, 105–112 (2009). https://doi.org/10.1007/s10840-008-9316-0

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  • DOI: https://doi.org/10.1007/s10840-008-9316-0

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