Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

Abstract

Obese patients receive more than twice the effective radiation dose of normal-weight patients during AF ablation procedures. Obesity needs to be considered in the risk-benefit ratio of AF ablation and should prompt further measures to reduce radiation exposure.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Otyłość powiązano również z większą dawką promieniowania i częstością występowania powikłań podczas ablacji AF [302,303]. Warto zauważyć, że poprawa objawowa po przezcewnikowej ablacji AF u otyłych pacjentów wydaje się podobna jak u pacjentów o prawidłowej masie ciała [298].…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…1,1241,1242,1243,1244,1245,1246,1247 Fluoroscopy is required for most components of the procedure, including catheter placement, positioning a multielectrode catheter into the CS, double transseptal catheterization, PV angiography, and LA ablation. A survey of the writing group members reveals that two-thirds use single-plane fluoroscopy, whereas one-third employ biplane.…”

“…One study reported a mean fluoroscopy time >60 minutes, with corresponding higher effective radiation doses in obese patients. 1244,1246 By using a vest containing 50–60 dosimeters to measure peak skin doses (PSDs), another study reported a mean PSD of 1.0 ± 0.5 Gy in the right anterior oblique and 1.5 ± 0.4 Gy in the left anterior oblique projection, during a mean fluoroscopy time of 67.8 ± 21 minutes. 1245 They estimated an overall lifetime risk of excess fatal malignancies normalized to 60 minutes of fluoroscopy of 0.07% for women and of 0.1% for men.…”

Radiation Risk From Medical Imaging

“…The effective radiation dose from radiographic and fluoroscopic examinations for patients with a high BMI can be much higher. 22,23 For patients undergoing CT, a high BMI often limits which radiation dose reduction techniques can be used. If patients with a high BMI are scanned with the same technique as patients with a lower BMI, the amount of incident radiation will be suboptimal and the resultant images will typically appear grainy or "noisy.…”