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Ge X, Chen M, Sha Z, Zhang J. Three-dimensional mapping in cardiac implantable electronic device - a feasible and effective alternative to fluoroscopy. J Interv Card Electrophysiol 2022; 66:783-792. [PMID: 35809160 DOI: 10.1007/s10840-022-01297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the last decade, three-dimensional mapping technology has substantially aided the development of cardiac implanted electronic devices (CIEDs). This article intends to present an outline of the use and benefits of three-dimensional (3D) mapping systems in CIEDs. RESULT As an alternative to fluoroscopy, 3D mapping greatly minimizes radiation exposure and eliminates the need for contrast dye during the implantation of CIEDs. Based on the visualization of the pacing lead tip and accurate anatomic reconstruction of the chamber of interest and a specialized mapping technique, 3D mapping technology dramatically improves the efficacy and success of the advanced cardiac implantable devices' placement. Additionally, it provides a superior option for those with complex medical conditions. CONCLUSION The use of 3D mapping technology in CIEDs has been proven feasible and effective by accumulating evidence. It is fair to anticipate that it will be widely used in CIED implantation in the future.
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Affiliation(s)
- Xiaozhen Ge
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Mengna Chen
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Zhongxin Sha
- Department of Cardiology, Guiyang First People's Hospital, Guizhou, China
| | - Junmeng Zhang
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China.
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L’Allier PL, Richer LP, McSpadden LC, Dorval JF. Peripheral Interventions Radiation Exposure Reduction Using a Sensor-Based Navigation System: A Proof-of-Concept Study. CJC Open 2021; 4:223-229. [PMID: 35198940 PMCID: PMC8843893 DOI: 10.1016/j.cjco.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background Intravascular catheter positioning is done with radiography imaging. Increasing evidence indicates excessive ionizing radiation exposure for patients and physicians during catheterization procedures, making solutions to reduce radiation exposure a priority. This study evaluated the feasibility and impact of using sensor-based magnetic navigation on (i) fluoroscopy time and (ii) positioning accuracy and safety of a peripheral angioplasty balloon catheter. Methods All patients (n = 10) underwent a balloon-positioning protocol using 2 navigation methods sequentially: (i) magnetic navigation with minimal fluoroscopy; (ii) fluoroscopic navigation. The navigation method order was randomized, and 4 consecutive placements per method were performed. A target vascular bifurcation was used as a fiduciary landmark for both methods to determine accuracy. Results Balloon placements were successful with both navigation methods in all subjects, and no adverse events occurred. Magnetic guidance led to significant reductions in fluoroscopy time (0.37 ± 1.5 vs 15.0 ± 8.1 seconds, P < 0.001) and dose (0.3 ± 1.2 vs 24.1 ± 23.8 μGy.m2, P < 0.01). The time duration for balloon alignment was similar for the 2 navigation methods (4.8 ± 1.4 vs 4.8 ± 2.3 seconds, P = 0.89), and the accuracy was almost identical (0.51 ± 0.41 vs 0.51 ± 0.32 mm, P = 0.97). Conclusions These results demonstrate the feasibility of using sensor-based magnetic guidance during simple peripheral interventional procedures; a significant reduction in ionizing radiation was achieved, with excellent positioning accuracy and safety. The clinical applications of magnetic guidance for device navigation during more complex percutaneous procedures should be evaluated.
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Rehani MM, Nacouzi D. Higher patient doses through X-ray imaging procedures. Phys Med 2020; 79:80-86. [PMID: 33189060 DOI: 10.1016/j.ejmp.2020.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023] Open
Abstract
Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of X-rays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators- but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.
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Affiliation(s)
| | - David Nacouzi
- Duke University Medical Center, Durham, NC 27708, USA
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Desai M, Kahaly O, Aslam A, Saifa-Bonsu J, Usmani M, Okabe T, Afzal MR, Houmsse M. Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review. Expert Rev Med Devices 2020; 17:1183-1192. [PMID: 32885677 DOI: 10.1080/17434440.2020.1819789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac electrophysiology (EP) procedures are frequently performed in patients with cardiac arrhythmias, chronic heart failure, and sudden cardiac death. Most EP procedures involve fluoroscopy, which results in radiation exposure to physicians, patients, and EP lab staff. Accumulated radiation exposure is a known health detriment to patients and physicians. AREA COVERED This review will summarize radiation exposure, dose metrics, complications of radiation exposure, factors affecting radiation exposure, minimizing radiation exposure, zero or near-zero fluoroscopy strategies, and up-to-date research in the area of reducing radiation exposure and best practices. EXPERT COMMENTARY Comprehensive strategies should be implemented in EP laboratories to minimize radiation exposure with standard fluoroscopy. There are routine techniques that can mitigate significant amounts of radiation exposure using standard equipment within the EP lab. The operators need to emphasize that EP practices routinely incorporate non-ionizing radiation sources for cardiac imaging (e.g. magnetic resonance imaging, advanced electroanatomical mapping systems, intracardiac ultrasonography) in addition to other novel technologies to mitigate radiation exposure to patients and physicians.
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Affiliation(s)
| | - Omar Kahaly
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Adil Aslam
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Jonnie Saifa-Bonsu
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Maham Usmani
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
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Qiu J, Wang Y, Chen G, Zhao C, Wang DW. Progress in zero-fluoroscopy implantation of cardiac electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:609-617. [PMID: 32348595 DOI: 10.1111/pace.13930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
Fluoroscopy is the imaging modality routinely used for cardiac device implantation. Due to the rising concern regarding the harmful effects of radiation exposure to both the patients and operation staffs, many efforts have been made to develop alternative techniques to achieve zero-fluoroscopy implantation. In this review, we describe the different methods aimed at avoiding the application of fluoroscopy in recent years, and evaluate their feasibility and safety in cardiac electronic device implantation.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Larsen TR, Saini A, Moore J, Huizar JF, Tan AY, Ellenbogen KA, Kaszala K. Fluoroscopy reduction during device implantation by using three-dimensional navigation. A single-center experience. J Cardiovasc Electrophysiol 2019; 30:2027-2033. [PMID: 31392815 DOI: 10.1111/jce.14102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/21/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of nonfluoroscopic three-dimensional electroanatomic mapping (3DM) systems reduces radiation exposure during ablation procedures. In this study, we sought to determine the value of 3DM during routine device implant procedures. METHODS Seventy nonselected patients underwent implantation of a single chamber, dual chamber, or biventricular device guided by Ensite (Abbott Laboratories) to limit fluoroscopy use and compared with 70 consecutive patients, who underwent matching procedures with standard fluoroscopy use (FL) in the period immediately preceding the use of 3DM. The venous anatomy, right atrium, and ventricle and coronary sinus were mapped with 0.035 inch J-wire, quadripolar catheter, and/or angioplasty wire. The leads were advanced under real-time visualization in Ensite. RESULTS 3DM reduced both fluoroscopy time and dose. Median fluoroscopy time for FL vs 3DM was 5.5 minutes (interquartile range [IQR]: 3.8-8.1) vs 0.9 minutes (IQR: 0.6-1.9) (P < .001) for single chamber devices, 6.3 minutes (IQR: 5.1-7.9) vs 3.3 minutes (IQR: 1.9-4) (P < .001) for dual-chamber devices, and 28.6 minutes (IQR: 19.6-36.2) to 14.7 minutes (IQR: 10.4-22.3) (P = .009) for biventricular devices, respectively. The median air kerma for FL vs 3DM was 15.4 mGy (IQR: 8.1-30.2) vs 4 mGy (IQR: 1.8-8) (P < .001) for single chamber devices, 16 mGy (IQR: 12-18.5) to 9.4 mGy (IQR: 7.5-11.3) (P = .001) for dual-chamber devices, and 324 mGy (IQR: 143-668.7) to 115 mGy (IQR:77-204) (P = .014) for biventricular devices, respectively. There were no procedural complications. At 3-month follow-up, there was no difference in voltage threshold measurements between the groups. CONCLUSION The use of 3DM leads to significantly reduced fluoroscopy time and fluoroscopy dose during routine device implantation.
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Affiliation(s)
- Timothy R Larsen
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Aditya Saini
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica Moore
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jose F Huizar
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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Miwa Y, Ueda A, Komeda M, Takeuchi S, Nagaoka M, Momose Y, Nonoguchi N, Hoshida K, Enomoto M, Togashi I, Maeda A, Hagiwara Y, Sato T, Soejima K. Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness. Open Heart 2019; 6:e000982. [PMID: 31297225 PMCID: PMC6593197 DOI: 10.1136/openhrt-2018-000982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/09/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022] Open
Abstract
Objective Recently, concern has increased regarding the hazards of radiation exposure in patients and laboratory staff. Since the numbers of complex catheter ablations (CA) performed, duration of procedure times, and need for multiple sessions have increased, radiation exposure during each session needs to be minimised. Our study aimed to assess the impact of awareness on radiation exposure during CA for atrial fibrillation (AF). Methods Mini-course lectures was delivered to the physicians and staff in the electrophysiology division. Its effect on the fluoroscopic time and radiation dose during AF ablation before (Group I, n=70), shortly after (Group II: n=70) and remotely after the mini-lecture (Group III, n=70) were evaluated. Patient demographics, preoperative testing and procedural parameters were collected. Results The fluoroscopic time significantly reduced after the lecture (Group I and II: 25.1±10.0 and 15.1±7.3 min, respectively (p<0.0001)), and remained so in Group III (13.0±5.4 min), despite the increase in the number of persistent AFs. The radiation dose also significantly reduced (Groups I, II, III: 295.0±263.0, 109.6±103.5 and 110.1±89.6 mGy, respectively (p<0.0001)). Conclusion Awareness on radiation exposure led to a significant reduction in fluoroscopic time and radiation dose during CA for AF, the effect of which persisted even to remote periods following the procedure.
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Affiliation(s)
- Yosuke Miwa
- Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Akiko Ueda
- Cardiac Morphology Unit, Department of Paediatrics, Royal Brompton Hospital, London, UK
| | | | | | - Mika Nagaoka
- Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Yuichi Momose
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Kyoko Hoshida
- Cardiology, Kyorin University Hospital, Tokyo, Japan
| | | | - Ikuko Togashi
- Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Akiko Maeda
- Division of Advanced Arrhythmia Management, Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Yo Hagiwara
- Division of Engineering, Kyorin University Hospital, Tokyo, Japan
| | - Toshiaki Sato
- Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Kyoko Soejima
- Cardiology, Kyorin University Hospital, Tokyo, Japan
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Daval C, Faroux L, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, Metz D. Impact of cardiac resynchronisation therapy on cardiologists' exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:489-497. [PMID: 30913548 DOI: 10.1088/1361-6498/ab1377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R2 = 0.21 during 'classical' implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.
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Affiliation(s)
- Charline Daval
- Department of Cardiology, Reims University Hospital, Reims, France
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Rogers AJ, Brodt CR. Minimizing Radiation in the Modern Electrophysiology Laboratory. J Innov Card Rhythm Manag 2018; 9:3265-3270. [PMID: 32494501 PMCID: PMC7252826 DOI: 10.19102/icrm.2018.090805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
Historically, the electrophysiology laboratory has relied heavily on the use of ionizing radiation in the form of fluoroscopy for a broad range of interventions and diagnostics. As the harmful effects of radiation have become increasingly recognized and procedural technologies have advanced, electrophysiologists have adopted new workflows. The purpose of this article is to review the available literature and experience in minimizing radiation in the modern electrophysiology laboratory. This review first covers general approaches to reducing fluoroscopy radiation in the electrophysiology suite, with concepts that apply across all procedure types. These include the reduction of infrared emission through fastidious fluoroscopy settings, new and proven solutions for radiation shielding, and methods of creating distance between the radiation source and the operator to reduce exposure. Following this discussion, we review specific task-based techniques for reducing radiation during special electrophysiologic procedures and workflows such as vascular access, coronary sinus lead placement, catheter manipulation, and periprocedural planning studies.
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Affiliation(s)
- Albert J. Rogers
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Chad R. Brodt
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
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12
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Thibault B, Macle L, Mondésert B, Dubuc M, Shohoudi A, Dyrda K, Guerra PG, Rivard L, Roy D, Talajic M, Khairy P. Reducing radiation exposure during procedures performed in the electrophysiology laboratory. J Cardiovasc Electrophysiol 2017; 29:308-315. [PMID: 29064134 DOI: 10.1111/jce.13373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Expert societies recently published strong recommendations to reduce the exposure of patients and staff to ionizing radiation (IR) during interventional and electrophysiology (EP) procedures. However, adherence to these guidelines remains difficult and the impact of implementing such recommendations is poorly characterized. METHODS AND RESULTS We conducted a single-center cohort study to quantify radiation exposure over time in three EP laboratories at the Montreal Heart Institute during 5,546 consecutive procedures from 2012 to 2015 by 11 primary operators. Overall, 2,618 (47.2%) procedures were catheter-based and 2,928 (52.8%) were device interventions. Interventions to reduce radiation exposure included educational initiatives to raise awareness (i.e., limiting cine acquisition, patient position, table height), slower frame rate, lower radiation dose per pulse, collimation, and integration with 3-D mapping systems and/or MediGuide technology. An 85% reduction in IR exposure was observed from 2012 to 2015, with the mean dose-area-product (DAP) decreasing from 7.65 ± 0.05 Gy·cm2 to 1.15 ± 0.04 Gy·cm2 (P < 0.001). This was true for catheter-based procedures (mean DAP 16.99 ± 0.08 to 2.00 ± 0.06 Gy·cm2 , P < 0.001) and device interventions (mean DAP 4.18 ± 0.06 to 0.64 ± 0.05 Gy·cm2 , P < 0.001). The median effective dose of IR recorded per quarter by 282 cervical dosimeters on EP staff decreased from 0.57 (IQR 0.18, 1.03) mSv in 2012 to 0.00 (IQR 0.00, 0.19) mSv in 2015, P < 0.001. CONCLUSION Enforcing good clinical practices with simple measures and low-dose fluoroscopy settings are highly effective in reducing IR exposure in the EP lab. These promising results should encourage other EP labs to adopt similar protective measures.
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Affiliation(s)
- Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Azadeh Shohoudi
- Montreal Health Innovations Coordinating Center, Montreal Heart Innovations Coordinating Center, Montrel Heart Institute, Université de Montréal, Montréal, Canada
| | - Katia Dyrda
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Peter G Guerra
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Léna Rivard
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
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13
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Crowhurst J, Haqqani H, Wright D, Whitby M, Lee A, Betts J, Denman R. Ultra-low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:947-954. [PMID: 28618036 DOI: 10.1111/pace.13141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electrophysiology procedures require fluoroscopic guidance, with the associated potentially adverse effects of ionizing radiation. Newer fluoroscopy systems have more features that enable dose-reduction strategies. This study aimed to investigate any reduction in radiation dose between an older fluoroscopy system (Philips Integris H5000, Philips Healthcare, Einhoven, Netherlands) and one of the latest systems (Siemens Artis Q, Siemens Healthcare, Erlangen, Germany), optimized with dose-reduction strategies. METHODS Radiation dose measures were collected over a 2-year period in a single electrophysiology laboratory. Procedures were separated into seven groups: devices, biventricular devices, electrophysiology studies, standard radiofrequency ablation, complex atrial ablation, ablation for ventricular arrhythmias, and pulmonary vein isolation. In the first year, an older fluoroscopy system was used, and in the second year, a new system, with dose reduction strategies. Comparisons were also made to the literature with regard to radiation dose levels. RESULTS Patient characteristics, fluoroscopy times, number of digital acquisitions, procedural times, and procedural success were largely similar between the old and new system across procedure groups. Overall dose area product (DAP) was reduced by 91% (5.0 [2.0-17.0] to 0.45 [0.16-2.61] Gycm2 [P > 0.001]) with the new system and was lower across all groups. DAP readings with the new system are some of the lowest published in the literature in all groups. CONCLUSION An optimized contemporary digital fluoroscopy system, with low radiation dose configuration and continued good procedural practice, can result in ultra-low radiation levels for all electrophysiology procedures, without compromising procedural time or procedural success.
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Affiliation(s)
- James Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Haris Haqqani
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Daniel Wright
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mark Whitby
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston Queensland, Australia
| | - Adam Lee
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - John Betts
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Russell Denman
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
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14
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DEL GRECO MAURIZIO, MAINES MASSIMILIANO, MARINI MASSIMILIANO, COLELLA ANDREA, ZECCHIN MASSIMO, VITALI-SERDOZ LAURA, BLANDINO ALESSANDRO, BARBONAGLIA LORELLA, ALLOCCA GIUSEPPE, MUREDDU ROBERTO, MARENNA BIONDINO, ROSSI PAOLO, VACCARI DIEGO, CHIANCA ROBERTO, INDIANI STEFANO, DI MATTEO IRENE, ANGHEBEN CARLO, ZORZI ALESSANDRO. Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry. J Cardiovasc Electrophysiol 2016; 28:85-93. [DOI: 10.1111/jce.13120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/18/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ALESSANDRO ZORZI
- Santa Maria del Carmine Hospital; Rovereto Italy
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padova; Padova Italy
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15
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Behar JM, Claridge S, Jackson T, Sieniewicz B, Porter B, Webb J, Rajani R, Kapetanakis S, Carr-White G, Rinaldi CA. The role of multi modality imaging in selecting patients and guiding lead placement for the delivery of cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2016; 15:93-107. [DOI: 10.1080/14779072.2016.1252674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Bradley Porter
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Jessica Webb
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ronak Rajani
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | | | | | - Christopher A Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
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