SPC365

Use of fluoroscopy and radiation exposure during AF ablation: a single-center 10-year experience

Session: Posters (Sessão 1 - Écran 1) - Ablação Fibrilhação Auricular
Speaker: MIGUEL VAZ ALMEIDA SOBRAL DOMINGUES

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Miguel Sobral Domingues; Daniel A. Gomes; Francisco Moscoso Costa; Gustavo Rodrigues; Daniel Matos; Gabriela Bem; João Carmo; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Francisco Belo Morgado; Pedro Adragão

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The number of patients referred for atrial fibrillation (AF) ablation has been increasing over the years. Currently, technological improvements make AF ablation a relatively fast and predictable procedure. Notwithstanding, the technique still relies on fluoroscopy, and its effects remain a concern for both patients and health care professionals. </span></span></span></p>

<p style="text-align:start">&nbsp;</p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The aim of this study was to assess the impact of technological advances on the use of fluoroscopy in AF ablation, and to analyze the radiation dose used in contemporary procedures.</span></span></span></p>

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<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-center prospective registry including patients submitted to first radiofrequency point-by-point pulmonary vein isolation (PVI) using CARTO&reg; mapping system since 2013 to November 2022. Patients with additional targets other than PVI, and those in whom single-shot techniques were employed, were excluded (n = 375). Fluoroscopy duration and absorbed (mGy) and effective dose of radiation (mSv) were assessed for each patient. Effective radiation dose was estimated by multiplying dose-area product (Gy.cm<sup>2</sup>) by a conversion coefficient of 0.15 mSv(Gy·cm<sup>2</sup>)<sup>&ndash;1</sup>.</span></span></span></p>

<p style="text-align:start">&nbsp;</p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 1027 patients (mean age 61 &plusmn; 11 years, 61.7% male, 81.4% with paroxysmal AF) were included. Overall, median fluoroscopy duration was 8.5 minutes (IQR 5.4-14.4). Over the last decade, there was a significant decrease of fluoroscopy times (from 20.7 [IQR 13.6-25.4] to 6.4 [IQR 4.5-10.7] minutes, <em>p for trend</em>&lt;0.001). The reduction of X-ray duration was more expressive from 2014 and 2015, corresponding to the introduction of pressure catheters (STSF&reg;) and image integration in electroanatomic mapping, respectively (<strong><span style="color:#4472c4">Figure 1</span></strong>). There was also a decrease on radiation dose over the years. In 2022, median absorbed radiation per procedure was 119mGy (IQR 69-223), and median estimated effective radiation dosage was 0.94mSv (IQR 0.68-3.95).</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Over the last decade there was a significant reduction in fluoroscopy use during AF ablation, associated with the introduction of newer technologies. PVI is currently a very low radiation exposure procedure, comparable to coronary calcium scoring. </span></span></span></p>