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Title: Pulmonary Vein Isolation for Atrial Fibrillation Can Be Achieved With Low Radiation Exposure.
Austin Authors: Huang, Alex L;Mughal, Nadeem;Tabas, Ferdinand;Patterson, Natalie L;Wong, Wen Kai;Whalley, David;Kanagaratnam, Logan
Affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
North Shore Heart Research Group, Kolling Institute, University of Sydney, Sydney, NSW, Australia
Issue Date: Jul-2018 2017-08-08
Publication information: Heart, Lung & Circulation 2018; 27(7): 812-818
Abstract: Atrial fibrillation is common and management by pharmacotherapy is limited by modest efficacy and significant toxicities. Pulmonary vein isolation (PVI) is a safe and effective alternative in select patients with atrial fibrillation. However, prolonged procedure time raises concerns of health risks from radiation exposure. This study aims to determine the significance of radiation exposure from PVI. In this study, we retrospectively reviewed patient demographics, fluoroscopy time, entrance skin dose and dose area product in 80 cases of PVI, radiofrequency ablation for atrial flutter and diagnostic coronary angiogram performed in our institution. Compared to other procedures, patients who underwent PVI were younger (age, mean±standard error of mean, 59.4±1.1 years old, p<0.0001) and were more likely to be male (82%, p<0.001). Body mass index was similar between the three groups. The median (and interquartile range) fluoroscopy time was similar between PVI (20.8 and 13.1-30.7mins) and flutter ablation (17.6 and 11.1-26.1mins) but longer than diagnostic angiography (4.2 and 2.3-6.7mins, p<0.0001). Entrance skin dose was similar between PVI and flutter ablation groups but significantly higher in the diagnostic angiography group, with median and IQR for PVI vs. flutter ablation vs. diagnostic angiography, 100.4 (52.8-179.9) vs. 73.2 (37.0-142.1) vs. 393.5 (276.1-555.6) mGy (p<0.0001). Dose area product in PVI (1831.2 and 887.7-3460.8cGycm2) was higher than flutter ablation (1077.8 and 452.9-2410.2cGycm2, p<0.05) but lower than the diagnostic angiography group (3446.8 and 2341.9-5283.1cGycm2, p<0.0001). The fluoroscopy time and entrance skin dose for PVI decreased over time, likely due to increased operator experience. Despite prolonged procedure time, radiation exposure from PVI was comparable to, or lower than, other fluoroscopy-guided cardiac procedures.
DOI: 10.1016/j.hlc.2017.07.005
PubMed URL: 28882497
Type: Journal Article
Subjects: Atrial fibrillation
Catheter Ablation
Pulmonary vein isolation
Appears in Collections:Journal articles

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