Cardiac arrhythmia catheter ablation procedures guided by x-ray imaging: N-acetylcysteine protection against radiation-induced cellular damage (CARAPACE study): study design

Valentina Catto, Giulia Stronati, Benedetta Porro, Susanna Fiorelli, Veronica Ricci, Chiara Vavassori, Eleonora Russo, Federico Guerra, Alessio Gasperetti, Valentina Ribatti, Rita Sicuso, Antonio Dello Russo, Fabrizio Veglia, Claudio Tondo, Viviana Cavalca, Gualtiero I. Colombo, Elena Tremoli, Michela Casella

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Catheter ablation (CA) procedures are characterized by exposure to ionizing radiations (IR). IR can cause DNA damage and may lead to carcinogenesis if not efficiently repaired. The primary endpoint of this study is to investigate whether intravenous administration of N-acetylcysteine prior to CA procedure may prevent systemic oxidative stress and genomic DNA damage induced by exposure to IR. Methods: The “Cardiac Arrhythmia catheter ablation procedures guided by x-Ray imaging: N-Acetylcysteine Protection Against radiation induced Cellular damagE” (CARAPACE) study is a prospective, randomized, single-blinded, parallel-arm monocenter study enrolling 550 consecutive patients undergoing CA at the Arrhythmology Unit of Centro Cardiologico Monzino (CCM). Inclusion criteria are age ≥ 18, indication for CA procedure guided by IR imaging, and written informed consent. IR levels will be measured via fluoroscopy time, effective dose, and dose area product. Glutathione and glutathione disulfide concentrations will be measured, and urinary levels of 8-iso-prostaglandin-F and 8-hydroxy-2-deoxyguanosine will be quantified. The enrolled patients will be randomized 1:1 to the N-acetylcysteine group or to the control group. Results: We expect that pre-operative administration of N-acetylcysteine will prevent IR-induced systemic oxidative stress. The study will provide data on oxidative DNA damage assessed by urinary 8-hydroxy-2-deoxyguanosine levels and direct evidence of genomic DNA damage in blood cells by comet assay. Conclusion: Catheter ablation procedures can lead to IR exposure and subsequent DNA damage. N-acetylcysteine administration prior to the procedure may prevent them and therefore lead to less possible complications. Trial registration: www.clinicaltrials.gov (NCT04154982)

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Catheter ablation
  • DNA damage
  • Fluoroscopy
  • Ionizing radiation
  • Oxidative stress
  • Radiological risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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