Fluoroscopy times in electrophysiology and device procedures: impact of single frame location fluoroscopy

This commentary refers to ‘The dream of near-zero X-rays ablation comes true’, by F. Gaita et al., 2016, pages 2749–2755. Gaita et al. 1 provide an excellent review of the potential of advancing technology in achieving a near-zero X-ray approach in the majority of electrophysiology procedures. Ionizing radiation are a health hazard to both the patient and operator,2 and hence the need of reducing radiation exposure is crucial. Although, the electroanatomical mapping systems have lead to significant reduction in fluoroscopy use in electrophysiology procedures, its use is not completely eliminated especially in left-heart procedures.3 The current European Heart Rhythm Survey has shown that X-ray hazard in electrophysiology and device procedures remains notable.4 Respecting the ALARA (radiation doses as low as reasonably achievable) principles should be mandatory in all interventional laboratories.5 We believe that non-gridded single frame location fluoroscopy is a useful tool to achieve low fluoroscopy times and doses in both electrophysiology and device procedures. We carried out a retrospective registry analysis of 496 device and electrophysiology procedures performed by a single operator at Barts Heart Centre over 5 years. Fluoroscopy times and procedural complications pre- and post-introduction of single frame location fluoroscopy (rather than continuous screening) in 2013 were noted. Two hundred and thirty-nine AF ablations and 257 simple and complex device procedures included. The reduction in fluoroscopy times over the years is shown in Figure 1. The initial drop in fluoroscopy times in EP procedures (2011–13) could be attributed to advances in mapping technology. However, the subsequent decrease in radiation exposure (EP, simple, and complex devices; 41.05 ± 12.18 vs. 2.02 ± 2.6; 12.46 ± 15.11 vs. 3.73 ± 3.14, and 28.70 ± 21.85 vs. 10 ± 8.85; P < 0.0001, 0.0001, and 0.0001) is attributable to change in fluoroscopy practice. No significant change in procedural complications was noted (P = 0.48, 0.6, and 0.52). Fluoroscopy times for electrophysiology, simple and complex device procedures. A significant reduction in fluoroscopy time was noted after the introduction of non-gridded single frame location fluoroscopy in 2013. Non-gridded single frame location fluoroscopy leads to significant reduction in radiation exposure. This is suitable for EP and device procedures wherein anatomical location of catheters is not effected by image quality. Reduction in radiation exposure can be achieved by using this technique without compromising the safety and effectiveness of the procedure. Exploring the role of this technique deserves further merit. Conflict of interest: none declared.