Key result
Use of a 3D-mapping system was significantly associated with achieving a fluoroscopy dose in the lowest quartile (OR 2.622; 95% CI 2.053-3.347; P<.001).
Why the study?
Fluoroscopy is essential in electrophysiology, but clear standards for acceptable x-ray exposure and recommendations to achieve them have been lacking.
Observational (n=1,788)
Yes
Odds Ratio: 2.622 (95% CI 2.053–3.347)
p-value: p=<.001
Fluoroscopy exposure during electrophysiological procedures varies widely, but significant reductions are associated with the use of 3D-mapping systems, monoplane x-ray systems, higher-volume centers, and female operators.
Background Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed. Hypothesis Current norms and quality markers required for optimal clinical routine can be identified. Methods Centers participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. Results Twenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm 2 , 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm 2 , 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm 2 , 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm 2 , 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001). Conclusion Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
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Kosiuk et al. (2020) conducted an observational in Electrophysiological procedures (n=1,788). 3D-mapping system vs. Without 3D-mapping system was evaluated on Fluoroscopy dose area product in the lower quartile (OR 2.622, 95% CI 2.053-3.347, p=<.001). Use of a 3D-mapping system was significantly associated with achieving a fluoroscopy dose in the lowest quartile (OR 2.622; 95% CI 2.053-3.347; P<.001).
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