X-ray exposure in cardiac electrophysiology: A retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.

Original languageEnglish
Article numbere008233
JournalJournal of the American Heart Association
Volume7
Issue number11
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Cardiac Electrophysiology
Fluoroscopy
X-Rays
Equipment and Supplies
Atrial Fibrillation
Cryosurgery
Ablation Techniques
Catheter Ablation
Ionizing Radiation
Neoplasms

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • X-ray

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b0c17e8fdf8a46ce91d5b70c8b72d4bb,
title = "X-ray exposure in cardiac electrophysiology: A retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory",
abstract = "Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.",
keywords = "Atrial fibrillation, Catheter ablation, X-ray",
author = "Michela Casella and Russo, {Antonio Dello} and Eleonora Russo and Valentina Catto and Francesca Pizzamiglio and Martina Zucchetti and Benedetta Majocchi and Stefania Riva and Giulia Vettor and Dessanai, {Maria Antonietta} and Gaetano Fassini and Massimo Moltrasio and Fabrizio Tundo and Carlo Vignati and Sergio Conti and Alice Bonomi and Corrado Carbucicchio and {Di Biase}, Luigi and Andrea Natale and Claudio Tondo",
year = "2018",
month = "6",
day = "1",
doi = "10.1161/JAHA.117.008233",
language = "English",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - X-ray exposure in cardiac electrophysiology

T2 - A retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory

AU - Casella, Michela

AU - Russo, Antonio Dello

AU - Russo, Eleonora

AU - Catto, Valentina

AU - Pizzamiglio, Francesca

AU - Zucchetti, Martina

AU - Majocchi, Benedetta

AU - Riva, Stefania

AU - Vettor, Giulia

AU - Dessanai, Maria Antonietta

AU - Fassini, Gaetano

AU - Moltrasio, Massimo

AU - Tundo, Fabrizio

AU - Vignati, Carlo

AU - Conti, Sergio

AU - Bonomi, Alice

AU - Carbucicchio, Corrado

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Tondo, Claudio

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.

AB - Background--Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results--We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P < 0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P < 0.0001) and a significant reduction of fluoroscopy use over time (P < 0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P < 0.001). Conclusions--Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.

KW - Atrial fibrillation

KW - Catheter ablation

KW - X-ray

UR - http://www.scopus.com/inward/record.url?scp=85048007909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048007909&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.008233

DO - 10.1161/JAHA.117.008233

M3 - Article

AN - SCOPUS:85048007909

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - e008233

ER -