Fluoroscopy-minimization strategy for catheter ablation of Supraventricular Tachycardia by wOmen OPerators: the STOOP Multicentre Registry

Aims: Occupational exposure to ionizing radiation in electrophysiology may significantly affect the careers of women of reproductive age. The aim of the STOOP registry was to quantify the estimated yearly occupational radiation exposure of female electrophysiologists of reproductive age performing consecutive radiofrequency catheter ablation (RFCA) for supraventricular tachycardia (SVT) adopting a fluoroscopy-minimization strategy. Methods: Twelve European centres participated. All procedures were performed with a fluoroscopy-minimization strategy, guided by 3D mapping systems and following the As Low As Reasonably Achievable (ALARA) principles. Results: A total of 710 RFCA procedures were performed by 32 operators (mean age38 ± 7 years). Mean procedure time was 80 ± 35 min, with a mean fluoroscopy time of 51 ± 153 s. The mean operator annual dose-area product (DAP) was 46.7 ± 79.5 Gy·cm², corresponding to an estimated mean annual effective dose of 9.34 ± 15.9 µSv. In no case did the yearly effective dose reach the 1 mSv occupational limit for pregnancy. The mean DAP did not differ among operators and was unaffected by operator experience or annual procedure volume. Conclusion: Performing SVT ablation with a fluoroscopy-minimization strategy results in operator radiation exposure far below the 1 mSv foetal dose constraint applicable once pregnancy is declared, irrespective of operator experience or case volume. These findings support the safety of continuing electrophysiology activity for women of reproductive age under modern fluoroscopy-free workflows.