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.