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Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with “ALARA” principles profoundly lowers total dose

Published online by Cambridge University Press:  22 August 2014

Robert H. Pass ,
Gregory G. Gates ,
Laura A. Gellis ,
Lynn Nappo  and
Scott R. Ceresnak
Robert H. Pass*
Affiliation:
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
Gregory G. Gates
Affiliation:
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
Laura A. Gellis
Affiliation:
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
Lynn Nappo
Affiliation:
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
Scott R. Ceresnak
Affiliation:
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
*
Correspondence to: R. H. Pass, MD, Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, R1 Bronx, NY 10467, United States of America. Tel: +718 741 2183; Fax: +718 654 3024; E-mail: [email protected]
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Abstract

Background: “ALARA – As Low As Reasonably Achievable” protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2–3 frames/second), low fluoro dose/frame (6–18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with “fast anatomical mapping” (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical–fluoroscopy technique. Conclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

Keywords

Paediatricablationradiationsupraventricular tachycardia
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 963 - 968
Copyright
© Cambridge University Press 2014 

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References

1. Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 2004; 15: 759–770.Google Scholar
2. Tanel, RE, Walsh, EP, Triedman, JK, Epstein, MR, Bergau, DM, Saul, JP. Five-year experience with radiofrequency catheter ablation: implications for management of arrhythmias in pediatric and young adult patients. J Pediatr 1997; 131: 878–887.Google Scholar
3. Mettler, FA Jr., Koenig, TR, Wagner, LK, Kelsey, CA. Radiation injuries after fluoroscopic procedures. Semin Ultrasound CT and MR 2002; 23: 428–442.Google Scholar
4. Venneri, L, Rossi, F, Botto, N, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council’s Biological Effects of Ionizing Radiation VII Report. Am Heart J 2009; 157: 118–124.Google Scholar
5. Wagner, LK, Eifel, PJ, Geise, RA. Potential biological effects following high X-ray dose interventional procedures. J Vasc Interv Radiol 1994; 5: 71–84.CrossRefGoogle ScholarPubMed
6. Clark, J, Bockoven, JR, Lane, J, Patel, CR, Smith, G. Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol 2008; 31: 283–289.CrossRefGoogle ScholarPubMed
7. Gist, K, Tigges, C, Smith, G, Clark, J. Learning curve for zero-fluoroscopy catheter ablation of AVNRT: early versus late experience. Pacing Clin Electrophysiol 2011; 34: 264–268.CrossRefGoogle ScholarPubMed
8. Miyake, CY, Mah, DY, Atallah, J, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 2011; 8: 519–525.Google Scholar
9. Von Bergen, NH, Bansal, S, Gingerich, J, Law, IH. Nonfluoroscopic and radiation-limited ablation of ventricular arrhythmias in children and young adults: a case series. Pediatr Cardiol 2011; 32: 743–747.Google Scholar
10. Gellis, LA, Ceresnak, SR, Gates, GJ, Nappo, L, Pass, RH. Reducing patient radiation dosage during pediatric SVT ablations using an “ALARA” radiation reduction protocol in the modern fluoroscopic era. Pacing Clin Electrophysiol 2013; 36: 688–694.CrossRefGoogle ScholarPubMed
11. Ubeda, C, Vano, E, Gonzalez, L, Miranda, P. Influence of the antiscatter grid on dose and image quality in pediatric interventional cardiology X-ray systems. Catheter Cardiovasc Interv 2013; 82: 51–57.Google Scholar
12. Partridge, J, McGahan, G, Causton, S, et al. Radiation dose reduction without compromise of image quality in cardiac angiography and intervention with the use of a flat panel detector without an antiscatter grid. Heart 2006; 92: 507–510.Google Scholar