Accurate Assessment of Patient Effective Radiation Dose and Associated Detriment Risk From Radiofrequency Catheter Ablation Procedures

Abstract

Background-Radiofrequency (RF) cardiac catheter ablation procedures may require extended fluoroscopic exposure resulting in elevated radiation risk. The aim of the present study was to accurately establish RF ablation radiation risk levels and to provide means for accurate patient risk estimation from studies performed in any electrophysiology laboratory. Methods and Results-Fluoroscopy required during cardiac ablation was classified into 4 types identified by beam orientation and irradiated tissue: (1) posteroanterior exposure during catheter advancing from the groin to the heart, (2) posteroanterior heart exposure, (3) left anterior oblique heart exposure, and (4) right anterior oblique heart exposure. The duration of each exposure was monitored in 24 patients undergoing RF cardiac ablation. Dose per minute of fluoroscopy was measured at 15 organs/tissues for each projection with the use of anthropomorphic phantom and thermoluminescence dosimetry. The effective dose rate was 219, 144, 136, and 112 Gy/min for groin-to-heart posteroanterior, posteroanterior, left anterior oblique, and right anterior oblique exposure, respectively. A typical ablation procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy. The average excess of fatal cancers was estimated to be 650 and 480 per million patients undergoing RF ablation requiring 1 hour of fluoroscopy for US and UK populations, respectively. The average risk for genetic defects was determined to be 1 per million births. Conclusions-Radiation risk from RF cardiac ablation is moderate compared with other complications, but it may highly exceed radiation risk from common radiological procedures. Efforts should be made toward minimization of patient radiation risk from RF ablation procedures. (Circulation. 2001;104:58-62.)

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction

“…[22][23][24][25][26][27] To our knowledge, none of these studies directly linked cumulative exposure and cancer risk. We examined a cohort of patients who had acute myocardial infarction and measured the association between low-dose ionizing radiation from cardiac imaging and therapeutic procedures and the risk of cancer.…”

Ablação com RF de arritmia na infância: registro observacional em 125 crianças

“…Another consideration that must be made is the greater risk of developing malignancies by exposure to fluoroscopy [6][7][8] . However, with a lower number of catheters used in the procedure, their cautious handling, shorter fluoroscopy exposure and use of non-fluoroscopic mapping, which have been recently used, the risk of complications can be reduced.…”

“…There are many variables that increase the complexity and risk of the procedure in this age group, such as vascular access limitations, small heart, possible anatomical variations due to the presence of congenital heart disease, lesion expansion and potential effects of exposure to radiation on developing cells [5][6][7][8][9][10] .…”

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

“…We refer to this method as the estimation method and used this calculation to compare with the direct and extrapolation methods. Yet another approach was used in studies by Lindsay et al 10 and Perisinakis et al, 13 in which fluoroscopy time was recorded in the individual projections during ablation, and in a separate step, an anthropomorphic phantom was loaded with dosimeters and radiated with the fluoroscopy parameters found in the human studies. In our study, the estimation method overestimated the skin dose by 57% in the RAO and by 108% in the LAO projection compared with the direct method.…”