Low-fluoro workflows and impact in radiation exposure in the electrophysiology lab

Abstract

\n \n \n Type of funding sources: None.\n \n \n \n \xa0During electrophysiology (EP) procedures, fluoroscopy imaging is employed to visualise catheters position in real-time. However, ionizing radiation is a health hazard to both the patient and operator. In recent years, the use of electroanatomical mapping systems and operator adoption of low-fluoro workflows has allowed a reduction of radiation exposure. The aim of this study was to assess the evolution of fluoroscopy time (FT) in EP procedures, using conventional technique or an electroanatomical mapping system (EMS).\n \n \n \n A retrospective analysis of consecutive EP procedures performed at a tertiary centre between September 2018 and October 2020 was conducted. The procedures were divided in 3 tertiles according to date (T1, T2 and T3), with T3 corresponding to the most recent interventions. Procedural duration, FT, use of EMS, radiofrequency time (RT), acute ablation success and procedural complications were examined.\n \n \n \n A total of 615 procedures were analysed: atrioventricular node reentry tachycardia (AVNRT) – n\u2009=\u2009144, accessory pathways (AP) – n\u2009=\u200983, typical atrial flutter – n\u2009=\u2009106, atrial fibrillation (AF) ablation with radiofrequency (RF) – n\u2009=\u200961, AF ablation with cryoballoon – n\u2009=\u200992, ablation of ventricular arrhythmias – n\u2009=\u200953, and 75 miscellaneous procedures (including atrioventricular node ablation, left atrial flutter ablation and cardioneuroablation). Mean age was 54.6\u2009±\u200918.2 years with 59.4% male sex patients. An EMS was used in 75% of the procedures, without significant differences between tertiles. A progressive reduction in median FT was observed over the tertiles (T1 6.3 min, interquartile range [IQR] 2.9-13.6; T2 5.4 min, IQR 2.1-12.0, and T3 3.1 min, IQR 1.2-7.2, Figure 1), and a statistical significant difference was found when comparing T1 to T3 (p\u2009<\u20090.001) and T2 to T3 (p\u2009<\u20090.001). The decrease in FT was observed throughout the study period for all different EP procedures (Figure 2). The number of procedures with zero fluoroscopy had gradually increased (T1 6.1%, T2 8.5% and T3 14.1%; T1 vs. T3 p <0.01). Younger patients (<20 years) were submitted to low fluoroscopy doses with a significant decrease over tertiles (T1 1.2 min, IQR 0.0-4.3; T2 0.9 min, IQR 0.0-2.5; T3 0.0, IQR 0.0-2.2, T1 vs.T3 p\u2009<\u20090.001). No significant difference in procedural duration, RT, acute procedural success or complication rate were noted between tertiles.\n \n \n \n Reduction in radiation exposure can be achieved without compromising duration, safety and effectiveness of the procedure.\xa0 The commitment of operators to reduce radiation exposure using 3D mapping technology can lead to a significant decrease in the use of fluoroscopy. Abstract Figure. Fluoroscopic time analysis\n