Co-Author(s):
Emily Buchanan, BS - Research Coordinator, Heart Rhythm Specialists
Texas Health Presbyterian Allen
1105 N Central Expy, Allen, TX 75013
Introduction | Objectives: Radiofrequency ablations (RFA) have been shown to be superior to medical management for reducing recurrence of arrhythmias. Despite current guidelines which detail that the usage of fluoroscopy indicate that the “as low as reasonably achievable”, radiation risk for RFA continues to be a moderate complication of ablations, RFAs use and average of 19 minutes or 210 mGy of ionizing radiation which is estimated to increase the risk of a fatal cancer for patients by up to 0.1 % per procedure. Use of high-density cardiac mapping systems in tandem with intracardiac echocardiography (ICE) has revolutionized the RFA workflow and allowed physicians to perform radiation-free procedures.
Methods: Retrospective Chart Analysis was performed on procedure records detailing ablations performed between January 1, 2013 and December 31, 2019. All patients underwent ablation procedures without the use of fluoroscopy via utilization of three-dimensional mapping systems. A total of 1936 consecutive non-epicardial ablation procedures were analyzed for procedure duration, use of fluoroscopy, and complication rates.
Results: Average procedure time of RFAs (157 ± 46 mins) was comparable to the literature (163 ± 41 mins). Zero ionizing radiation was used in these cases (0 mins, 0 mGy) as compared to traditional RFA procedures (19mins, 210mGy). Complications were observed in 1.08% of cases as compared to tradition RFAs with complication rates of 2.90%. Lead displacement which is a unique complication of the zero-fluoroscopy technique occurred in 0.10% of all cases. Vascular complications including hematoma, pseudoaneurysm, and AV fistula were observed in 0.52% of cases as compared with traditional RFA vascular complications at 1.40%. Pericardial effusion and/or cardiac tamponade was observed in 0.52% of cases as compared with historical values at 1.70%. No deaths were observed as compared to historical rates of 0.06%.
Conclusions: Mitigating radiation exposure is crucial to the field of electrophysiology, since RFA procedures require extensive imaging throughout multiple procedures. In the era of new technologies that allow a physician to effectively and safely perform RFAs without the aid of fluoroscopy, we must actively work to foster a no exposure, no radiation mindset in the medical community.