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.
X-ray exposure in cardiac electrophysiology: A retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory / Casella, M.; Dello Russo, A.; Russo, E.; Catto, V.; Pizzamiglio, F.; Zucchetti, M.; Majocchi, B.; Riva, S.; Vettor, G.; Dessanai, M. A.; Fassini, G.; Moltrasio, M.; Tundo, F.; Vignati, C.; Conti, S.; Bonomi, A.; Carbucicchio, C.; Di Biase, L.; Natale, A.; Tondo, C.. - In: JOURNAL OF THE AMERICAN HEART ASSOCIATION. CARDIOVASCULAR AND CEREBROVASCULAR DISEASE. - ISSN 2047-9980. - 7:11(2018). [10.1161/JAHA.117.008233]