Minimizing Radiation in the Modern Electrophysiology Laboratory

Abstract

Historically, the electrophysiology laboratory has relied heavily on the use of ionizing radiation in the form of fluoroscopy for a broad range of interventions and diagnostics. As the harmful effects of radiation have become increasingly recognized and procedural technologies have advanced, electrophysiologists have adopted new workflows. The purpose of this article is to review the available literature and experience in minimizing radiation in the modern electrophysiology laboratory. This review first covers general approaches to reducing fluoroscopy radiation in the electrophysiology suite, with concepts that apply across all procedure types. These include the reduction of infrared emission through fastidious fluoroscopy settings, new and proven solutions for radiation shielding, and methods of creating distance between the radiation source and the operator to reduce exposure. Following this discussion, we review specific task-based techniques for reducing radiation during special electrophysiologic procedures and workflows such as vascular access, coronary sinus lead placement, catheter manipulation, and periprocedural planning studies.

Influence of excess weight and obesity on performance and outcome of pulmonary vein isolation with the cryoballoon

“…It has been widely shown that obesity has a major impact on radiation exposure of both patients and the operator [22,23]. Reduction of radiation with special protocols and being aware of different radiation exposure in different system angulations is important for every intervention but must especially kept in mind in obese patients [24,25]. In our laboratory we reduce the frame rate per second (fps) to 3 fps whenever possible, collimate the beam, keep the distance of the detector and the patient as low as possible and try to store taken fluoroscopy loops instead of filming again.…”

Effect of fluoroscopy frame rate on radiation exposure and in‐hospital outcomes in three‐dimensional electroanatomic mapping guided procedures

“…All the procedures were performed in the same electrophysiology laboratory using the Philips Allura Xper FD 10 system (Philips Healthcare, Best, the Netherlands). Electroanatomic mapping was done using the Carto system (Biosense Webster, CA, USA) 2,3 …”

“…Electroanatomic mapping was done using the Carto system (Biosense Webster, CA, USA). 2,3 The effective dose (ED, in mSv) was derived from DAP values provided by the X-ray system by multiplying it with a conversion factor. The conversion factors used for adult males and females were 0.2 and 0.28, respectively.…”

Minimizing Radiation—Why Aren’t We Down to Zero?

“…It is within this context that Rogers and Brodt 16 provide a well-written and important narrative review that discusses the potential hazards of ionizing radiation exposure, general approaches for decreasing fluoroscopy, and specific task-based alternatives to fluoroscopy. This is a must-read for a cardiologist and especially the proceduralist.…”