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Krmek N, Környei L, Kralik I, Delić-Brkljačić D, Milošević M, Rode M, Kocsis F, Radeljić V. X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart. Pediatr Cardiol 2024; 45:804-813. [PMID: 38411709 DOI: 10.1007/s00246-024-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024]
Abstract
The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.
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Affiliation(s)
- Nikola Krmek
- University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - László Környei
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
| | | | | | | | - Mirta Rode
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Flóra Kocsis
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
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Purtell CS, Kipp RT, Eckhardt LL. Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology. Curr Cardiol Rep 2021; 23:28. [PMID: 33655436 PMCID: PMC7925460 DOI: 10.1007/s11886-021-01461-y] [Citation(s) in RCA: 3] [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] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.
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Affiliation(s)
- Christopher S Purtell
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA
| | - Ryan T Kipp
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Lee L Eckhardt
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA. .,Cellular and Molecular Arrhythmia Research Program, Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 2020; 179:1197-1204. [PMID: 32529398 DOI: 10.1007/s00431-020-03701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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Zhang G, Cheng L, Liang Z, Zhang J, Dong R, Hang F, Wang X, Wang Z, Zhao L, Wang Z, Wu Y. Zero-fluoroscopy transseptal puncture guided by right atrial electroanatomical mapping combined with intracardiac echocardiography: A single-center experience. Clin Cardiol 2020; 43:1009-1016. [PMID: 32506504 PMCID: PMC7462191 DOI: 10.1002/clc.23401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background Right atrial electroanatomical mapping may be combined with SoundStar 3D diagnostic ultrasound catheter (EAM‐ICE) as a zero‐fluoroscopy procedure for radiofrequency catheter ablation (RFCA). We aimed to evaluate the efficiency and safety of zero‐fluoroscopy transseptal puncture guided by EAM‐ICE and fluoroscopy combined with intracardiac echocardiography (F‐ICE) in patients with paroxysmal atrial fibrillation (PAF). Hypothesis Zero‐fluoroscopy transseptal puncture is an effective and safe procedure. Methods This study had a prospective design. A total of 57 patients with PAF were enrolled and assigned to two groups. Twenty‐seven patients were enrolled in the EAM‐ICE group, and 30 patients were enrolled in the F‐ICE group. Results There were no statistically significant differences in baseline patient characteristics between groups. Transseptal puncture was successful in all patients (57/57, 100%). Total procedure time and duration of transseptal puncture were lower in the F‐ICE group (199.4 ± 26.0 minutes vs 150.7 ± 22.1 minutes, P = 0.000; 118.4 ± 19.7 vs 70.5 ± 13.5 minutes, P = 0.000). There was no use of fluoroscopy in the EAM‐ICE group (0 mGy vs 70.5 ± 13.5 mGy); the duration of fluoroscopy in the EAM‐ICE group was negligible (0 minutes vs 5.4 ± 1.9 minutes). No procedural complication occurred in either group. Conclusions EAM‐ICE guided zero‐fluoroscopy transseptal puncture is an effective and safe procedure.
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Affiliation(s)
- Guangping Zhang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Liting Cheng
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Zhuo Liang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Junmeng Zhang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Ruiqing Dong
- Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Fei Hang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Xinlu Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Ziyu Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Lin Zhao
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Zefeng Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
- Department of Lung and Blood Vessel DiseaseBeijing Institute of HeartBeijingChina
| | - Yongquan Wu
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
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Canpolat U, Faggioni M, Della Rocca DG, Chen Q, Ayhan H, Vu AA, Mohanty S, Trivedi C, Gianni C, Bassiouny M, Al-Ahmad A, Burkhardt JD, Sanchez JE, Gallinghouse GJ, Natale A, Horton RP. State of Fluoroless Procedures in Cardiac Electrophysiology Practice. J Innov Card Rhythm Manag 2020; 11:4018-4029. [PMID: 32368376 PMCID: PMC7192123 DOI: 10.19102/icrm.2020.110305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
In the past decade, the use of interventional electrophysiological (EP) procedures for the diagnosis and treatment of cardiac arrhythmias has exponentially increased. These procedures usually require fluoroscopy to guide the advancement and frequent repositioning of intracardiac catheters, resulting in both the patient and the operator being subjected to a considerable degree of radiation exposure. Although shielding options such as lead gowns, glasses, and pull-down shields are useful for protecting the operator, they do not lessen the patient’s level of exposure. Furthermore, the prolonged use of lead gowns can exponentiate the onset of orthopedic problems among operators. Recent advancements in three-dimensional cardiac mapping systems and the use of radiation-free imaging technologies such as magnetic resonance imaging and intracardiac ultrasound allow operators to perform EP procedures with minimal or even no fluoroscopy. In this review, we sought to describe the state of fluoroless procedures in EP practice.
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Affiliation(s)
- Ugur Canpolat
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | | | | | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Huseyin Ayhan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, Ankara Yildirim Beyazit, Ankara, Turkey
| | - Andrew A Vu
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Mohammed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve, University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Stanford University, Stanford, CA, USA.,Dell Medical School, University of Texas, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA.,Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX, USA
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