RESUMO
Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose-area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP (p< 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time (p< 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar.
Assuntos
Ablação por Cateter , Exposição à Radiação , Adolescente , Adulto , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R2 = 0.21 during 'classical' implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.
Assuntos
Terapia de Ressincronização Cardíaca , Cardiologia , Desfibriladores Implantáveis , Exposição Ocupacional/análise , Marca-Passo Artificial , Implantação de Prótese , Exposição à Radiação/análise , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/efeitos adversosRESUMO
OBJECTIVES: We aimed to measure the reduction in the estimated dose of radiation received by patients that can be achieved using dose-reduction technology (ClarityIQ, Philips Healthcare, The Netherlands), among all patients undergoing invasive cardiology procedures. BACKGROUND: Medical procedures remain the primary source of exposure to ionizing radiation in the general population. METHODS: The study population comprised all patients (without exclusion criteria) undergoing invasive coronary procedures over a 1-year study period in a large referral centre equipped with two catheterization laboratories (cathlabs). Both cathlabs (A and B) were equipped with the Allura Xper FD10 imaging system (Philips Healthcare, The Netherlands), but only Cathlab B was equipped with ClarityIQ technology. The primary endpoint was the estimated total dose of radiation received by the patient, as assessed by Air Kerma (AK) and dose area product (DAP). RESULTS: In total, 2095 invasive coronary procedures were analyzed. The patients who underwent procedures in Cathlab B received an average estimated dose that was 23% (AK) and 43% (DAP) lower than the dose received by patients undergoing procedures in Cathlab A (P < .0001). The reduction remained significant by multivariate analysis after adjustment for total X-ray time, body mass index, arterial approach, PCI of at least one lesion, sex, and patient age. CONCLUSION: In our study, the ClarityIQ technology reduced the estimated radiation dose received by patients by 23-43%, according to the method of measurement.
Assuntos
Cateterismo Cardíaco/métodos , Angiografia Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Proteção Radiológica/métodos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The impact of novel alternative access and valve type on radiation exposure during transcatheter aortic valve replacement (TAVR) has not yet been evaluated. This study sought to determine the impact of a transarterial approach and prosthesis type on physician and patient exposure to radiation during TAVR. METHODS: This was a prospective study including 140 consecutive patients undergoing TAVR by transfemoral (n = 102) or transcarotid (TC) (n = 38) access at 2 centers. Implanted valves were the self-expanding Evolut R/PRO system (Medtronic, Minneapolis, MN; n = 38) and the balloon-expandable SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA; n = 102). The primary endpoint was first operator radiation exposure. The secondary endpoint was patient radiation exposure. RESULTS: First operator radiation exposure was 4-fold greater during TC TAVR (P < .001). The use of a self-expanding valve was associated with a longer x-ray time (P = .015) and a 2-fold greater first operator radiation dose (P = .018). Patient radiation dose was not significantly affected by arterial approach (P = .055) or valve type (P = .095). After adjustment for potential confounders, the TC approach remained associated with a 174.8% (95% confidence interval, 80.6-318.3, P < .001) increase in first operator radiation dose, whereas the use of a self-expanding valve no longer influenced the first operator dose (P = .630). CONCLUSIONS: TC access and the use of a self-expanding valve were associated with a 4- and 2-fold greater first operator radiation exposure during TAVR procedures, respectively. Unlike the arterial approach, the effect of bioprosthesis type on radiation exposure was mainly related to x-ray time and was no longer significant after adjustment.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Exposição à Radiação/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Artérias Carótidas , Feminino , Artéria Femoral , Humanos , Masculino , Exposição Ocupacional , Segurança do Paciente , Estudos Prospectivos , Desenho de PróteseRESUMO
Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fluoroscopia/efeitos adversos , Medição de Risco/métodos , Tomografia Computadorizada por Raios X/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Masculino , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Patients who underwent radiofrequency ablation of atrial fibrillation are exposed to X-rays not only during the procedure but also during the preprocedural computed tomography. No study has investigated the cumulative effective dose received by patients who underwent atrial fibrillation ablation and identified factors influencing this dose. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent radiofrequency ablation of atrial fibrillation. The secondary objective was to estimate the impact of obesity on this exposure. All patients who underwent a first attempt of radiofrequency ablation of atrial fibrillation in our center over a 21 months period were included. Dosimetric indicators from preprocedural computed tomography and the ablation procedure were collected and converted into an effective dose. A total of 144 radiofrequency ablation of atrial fibrillation were included. The mean cumulative effective dose was 11.4 mSv, and 82% of the dose was from the computed tomography. Obese patients received a dose that was 75% higher than normal-weight patients, and this increase remained significant by multivariate analysis. In conclusion, overall exposure to ionizing radiation for patients who underwent radiofrequency ablation of atrial fibrillation seems acceptable, and the majority of the overall effective dose comes from the computed tomography. Obese patients are exposed to a 75% higher dose than normal-weight patients.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Obesidade/complicações , Exposição à Radiação/efeitos adversos , Lesões por Radiação/epidemiologia , Tomografia Computadorizada por Raios X/efeitos adversos , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Relação Dose-Resposta à Radiação , Feminino , Fluoroscopia/efeitos adversos , Seguimentos , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Interventional cardiologists count among the health professionals that are most exposed to ionising radiation. To minimise exposure, it is recommended that the patient be placed at the maximum distance possible from the X-ray source, but this recommendation has not been clinically validated. We aimed to investigate the impact of the average table height on the level of radiation delivered to cardiologists performing coronary interventions. The population for analysis included all invasive coronary procedures performed in our centre from March to June 2017. The primary endpoint was operator radiation exposure, as assessed using personal electronic dosimeters located on the operator's left arm. In total, 225 invasive coronary procedures were analysed. When the average table height was 1126 mm or more, the operators received a radiation dose that was, on average, 53% lower than when the table was lower than 1126 mm. This reduction remained significant by multivariate analysis adjusted for the operator.
Assuntos
Cardiologistas/estatística & dados numéricos , Exposição Ocupacional/análise , Intervenção Coronária Percutânea/métodos , Exposição à Radiação/análise , Radiografia Intervencionista/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Feminino , Fluoroscopia , Humanos , Masculino , Estudos Prospectivos , Doses de Radiação , Radiação Ionizante , Fatores de RiscoRESUMO
PURPOSE: Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no study comparing the level of exposure of physicians during different electrophysiology procedures. We aimed to measure and compare cardiologists' exposure to radiation during different electrophysiology procedures. METHODS: The study population comprised all electrophysiology procedures performed over a 6-month period in a large referral centre. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on the operator's left arm. RESULTS: In total, 150 electrophysiology procedures were analyzed. Compared with electrophysiology studies (reference category), physician radiation exposure was 3-fold greater during ablation of atrial fibrillation, 9-fold greater during ablation of atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentrant tachycardia (AVNT), and 10-fold greater during ablation of atrial flutter (p < 0.001). Physician exposure was mainly related to X-ray time (R2 = 0.28). CONCLUSIONS: Our study showed significant differences in cardiologists' exposure to ionizing radiation depending on the type of electrophysiology procedure. Atrial flutter and AVNRT/AVNT ablations are the procedures in which operators are most exposed to ionizing radiation.
Assuntos
Cardiologistas , Técnicas Eletrofisiológicas Cardíacas , Exposição Ocupacional , Exposição à Radiação , França , Humanos , Radiometria , Fatores de RiscoRESUMO
Exposure of operators to ionising radiation in interventional cardiology has likely diminished, but data confirming the magnitude of the reduction are lacking. The aim of this study was to compare the dose of radiation received by interventional cardiology operators at 11â¯years interval (2006 vs 2017). The study population comprised all interventional coronary procedures performed by a single operator in one catheterization laboratory (cathlab) of a large university hospital in north-eastern France. Exposure was compared between two periods, namely period 1 (from October 2005 to March 2006) and period 2 (from March 2017 to June 2017). The primary endpoint was the dose of radiation received by the operator, measured using an electronic dosimeter placed on the operator's left arm. In 2017, the dose of radiation received by the operators was, on average, 95% lower than the dose received in 2006 (pâ¯<â¯0.0001), even though the average fluoroscopy time increased by 73% over the same period (pâ¯<â¯0.0001). By multivariable analysis including body mass index, fluoroscopy time and performance of at least one (1) coronary angioplasty, the reduction in the operator's exposure to radiation remained significant. The dose of radiation received by interventional cardiology operators has decreased by 95% over the last ten years.
Assuntos
Cardiologistas/tendências , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Radiação Ionizante , Idoso , Cardiologistas/normas , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/normas , Estudos Prospectivos , Dosímetros de Radiação , Fatores de Risco , Fatores de TempoRESUMO
Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade.
Assuntos
Angiografia Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Fluoroscopia/efeitos adversos , Previsões , Intervenção Coronária Percutânea/métodos , Lesões por Radiação/epidemiologia , Idoso , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Lesões por Radiação/etiologia , Fatores de RiscoAssuntos
Cateterismo Cardíaco/instrumentação , Cardiologistas , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Intervenção Coronária Percutânea/instrumentação , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/instrumentação , Radiologistas , Idoso , Cateterismo Cardíaco/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Salas Cirúrgicas , Intervenção Coronária Percutânea/efeitos adversos , Doses de Radiação , Exposição à Radiação/efeitos adversos , Monitoramento de Radiação , Proteção Radiológica , Radiografia Intervencionista/efeitos adversos , Fatores de TempoRESUMO
AIMS: Although underestimated by interventional cardiologists for a long time, radiation exposure of operators and patients is currently a major concern. The objective of the present operator-blinded registry was to compare related-peripheral arterial route radiation exposure of operators. METHODS AND RESULTS: During 420 consecutive coronary angiograms (CAs) and percutaneous coronary interventions (PCIs), four interventional cardiologists were blindly screened. Radiation exposures were assessed using electronic personal dosimeters. Protection of operator was ensured using a lead apron, low leaded flaps, and leaded glass. Radiation exposure of operators was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs: 29.0 [1.0-195.0] microSv vs. 13.0 [1.0-164.0] microSv; P < 0.0001 and 69.5 [4.0-531.0] microSv vs. 41.0 [2.0-360.0] microSv; P = 0.018, respectively. Similarly, radiation exposure of patients was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs. Moreover, procedural durations and fluoroscopy times were significantly higher throughout the radial route. CONCLUSIONS: Although the radial route decreases peripheral arterial complication rates, increased radiation exposure of operators despite extensive use of specific protection devices is currently a growing problem for the interventional cardiologist health. Radial route indication should be promptly reconsidered in the light of the present findings.