Key result
The addition of CARTO 3 to ALARA protocols significantly reduced mean air Kerma radiation exposure (13.1 vs 93.8 mGy; P<0.001) during paediatric supraventricular tachycardia ablation.
Why the study?
Does the addition of CARTO 3 electroanatomical mapping to ALARA protocols reduce radiation exposure in paediatric patients undergoing SVT ablation?
Cohort (n=75)
Does the addition of CARTO 3 electroanatomical mapping to ALARA protocols reduce radiation exposure in paediatric patients undergoing SVT ablation?
Absolute Event Rate: 13.1% vs 93.8%
p-value: p=<0.001
The addition of CARTO 3 electroanatomical mapping to ALARA protocols significantly reduces radiation exposure during paediatric SVT ablations without compromising procedural efficacy or safety.
ALARA plus CARTO 3 mapping was associated with lower radiation in SVT ablation; leaves open whether routine integration improves safety outcomes.
BACKGROUND: "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. METHODS: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2-3 frames/second), low fluoro dose/frame (6-18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with "fast anatomical mapping" (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. RESULTS: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical-fluoroscopy technique. CONCLUSIONS: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.
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Pass et al. (2014) conducted a cohort in Supraventricular tachycardia (n=75). ALARA protocol with CARTO 3 (ALARA+C3) vs. ALARA protocol alone was evaluated on Mean air Kerma radiation dose (p=<0.001). The addition of CARTO 3 to ALARA protocols significantly reduced mean air Kerma radiation exposure (13.1 vs 93.8 mGy; P<0.001) during paediatric supraventricular tachycardia ablation.
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