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Low-fluoro workflows and impact in radiation exposure in the electrophysiology laboratory
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Vera Ferreira; Guilherme Portugal; Madalena Coutinho Cruz; Pedro Silva Cunha; Bruno Tereno Valente; Ana Lousinha; Alexandra Castelo; Pedro Garcia Brás; José Miguel Viegas; Ana Sofia Almeida; Cátia Guerra; Margarida Paulo; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><strong>Background: </strong>During </span><span style="font-size:12.0pt">electrophysiology (EP) procedures</span><span style="font-size:12.0pt">, fluoroscopy imaging is employed to visualise catheters position in real-time. </span><span style="font-size:12.0pt"><span style="color:black">However, ionizing radiation is a health hazard to both the patient and operator. In recent years, the use of electroanatomical mapping systems and operator adoption of low-fluoro workflows has allowed a reduction of radiation exposure. </span></span><span style="font-size:12.0pt">The aim of this study was to assess the evolution of fluoroscopy time (FT) in EP procedures, using conventional technique or an electroanatomical mapping system (EMS). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><strong>Methods:</strong> A retrospective analysis of consecutive EP procedures performed at a tertiary centre between September 2018 and October 2020 was conducted. The procedures were divided in 3 tertiles according to date (T1, T2 and T3), with T3 corresponding to the most recent interventions. Procedural duration, FT, use of EMS, radiofrequency time (RT), acute ablation success and procedural complications were examined. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><strong><span style="color:black">Results: </span></strong><span style="color:black">A total of </span>615 procedures were analysed: <span style="color:black">atrioventricular node reentry tachycardia (AVNRT) – n=144, accessory pathways (AP) – n=83, typical atrial flutter – n=106, atrial fibrillation (AF) ablation with radiofrequency (RF) – n=61, AF ablation with cryoballoon – n=92, ablation of ventricular arrhythmias – n=53, and 75 miscellaneous procedures (including atrioventricular node ablation, left atrial flutter ablation and cardioneuroablation). </span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="color:black">M</span></span></span><span style="font-size:12.0pt">ean age was 54.6±18.2 years with 59.4% male sex patients. An EMS was used in 75% of the procedures, without significant differences between tertiles. </span><span style="font-size:12.0pt"><span style="color:black">A progressive reduction in median FT was observed over the tertiles (T1 6.3 min, interquartile range [IQR] 2.9-13.6;</span></span><span style="font-size:12.0pt"> T2 5.4 min, IQR 2.1-12.0, and T3 3.1 min, IQR 1.2-7.2, Figure 1), and a </span><span style="font-size:12.0pt">statistical significant difference was found when comparing T1 to T3 (p<0.001) and T2 to T3</span><span style="font-size:12.0pt"> (p<0.001). The decrease in FT was observed throughout the study period for all different EP procedures (Figure 2). The number of procedures with zero fluoroscopy had gradually increased (T1 6.1%, T2 8.5% and T3 14.1%; T1 vs. T3 p <0.01). Younger patients (<20 years) were submitted to low fluoroscopy doses with a significant decrease over tertiles (<span style="color:black">T1 1.2 min, IQR 0.0-4.3;</span> T2 0.9 min, IQR 0.0-2.5; T3 0.0, IQR 0.0-2.2, T1 vs.T3 p<0.001). No significant difference in procedural duration, RT, acute procedural success or complication rate were noted between tertiles. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusion: </span></strong><span style="font-size:12.0pt">Reduction in radiation exposure can be achieved without compromising duration, safety and effectiveness of the procedure. The commitment of operators to reduce radiation exposure using 3D mapping technology can lead to a significant decrease in the use of fluoroscopy.</span></span></span></p>
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