Risk of Ionizing Radiation in Women of Childbearing Age undergoing Radiofrequency Ablation

Abstract

BackgroundThe International Commission of Radiology recommends a pregnancy screening test to all female patients of childbearing age who will undergo a radiological study. Radiation is known to be teratogenic and its effect is cumulative. The teratogenic potential starts at doses close to those used during these procedures. The prevalence of positive pregnancy tests in patients undergoing electrophysiological studies and/or catheter ablation in our midst is unknown. ObjectiveTo evaluate the prevalence of positive pregnancy tests in female patients referred for electrophysiological study and/or radiofrequency ablation. MethodsCross-sectional study analyzing 2,966 patients undergoing electrophysiological study and/or catheter ablation, from June 1997 to February 2013, in the Institute of Cardiology of Rio Grande do Sul. A total of 1490 procedures were performed in women, of whom 769 were of childbearing age. All patients were screened with a pregnancy test on the day before the procedure. ResultsThree patients tested positive, and were therefore unable to undergo the procedure. The prevalence observed was 3.9 cases per 1,000 women of childbearing age. ConclusionBecause of their safety and low cost, pregnancy screening tests are indicated for all women of childbearing age undergoing radiological studies, since the degree of ionizing radiation needed for these procedures is very close to the threshold for teratogenicity, especially in the first trimester, when the signs of pregnancy are not evident.

Supraventricular tachycardia and syncope during pregnancy: A case for catheter ablation without fluoroscopy

“…Exposure during an electrophysiological study is approximately 25 mGy/min, resulting in a mean total exposure of 0.07 Gy. 4,5 Doses higher than 0.10---0.20 Gy are associated with teratogenic effects; this figure is close to that used in one hour of fluoroscopy. 5 We describe the case of a pregnant woman who presented syncope due to drug-refractory SVT who underwent catheter ablation without the use of fluoroscopy.…”

“…5,6,7 However, the development of nonfluoroscopic mapping systems has opened up the possibility of pregnant patients undergoing invasive procedures without exposure to ionizing radiation. We recently published our experience with a zero radiation policy in our department 8 ; although there were no pregnant women in the initial series, the methodology in the case presented was exactly the same.…”

Electrophysiological Studies and Radiofrequency Ablations in Children and Adolescents with Arrhythmia

“…In our institution, serum beta-hCG test was performed on all female patients of childbearing age, which according to the World Health Organization encompasses the ages between 10 and 50 years. The exposure of women of childbearing age to ionizing radiation during RF ablation imposes a substantial risk of teratogenicity due to the susceptibility of the fetus during the entire prenatal period 22 . Based on that, screening was conducted to identify potentially unidentified pregnancies at the time of the procedure.…”

Tratamento de taquicardia supraventricular sincopal durante a gestação sem uso de raios‐X: relato de caso

“…A exposição em um estudo eletrofisiológico é aproximadamente de 25 m Gray (Gy)/min, em média de 0,07 Gy 4,5 . O potencial teratogênico inicia com 0,10-0,20 Gy, muito próximo do utilizado durante uma hora de fluoroscopia 5 . Aqui fazemos o relato de mulher na gestação que apresentou TSV, sincopal, refratária ao tratamento a qual foi submetida a ablação por cateter sem o uso de fluoroscopia.…”