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Adeliño R, Malaczynska-Rajpold K, Perrotta L, Manninger M, Vanduynhoven P, Nesti M, Goanță EV, Waldmann V, Pavlovic N, Farkowski MM, Guerra JM, Penela D, Boveda S, Chun JKR. Occupational radiation exposure of electrophysiology staff with reproductive potential and during pregnancy: an EHRA survey. Europace 2023; 25:euad216. [PMID: 37498147 PMCID: PMC10401324 DOI: 10.1093/europace/euad216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. The study is aimed at investigating the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, exploring the safety measures adopted in different EP labs, and verifying the adherence to the current guidelines. METHODS AND RESULTS An online survey was conducted using the European Heart Rhythm Association (EHRA) infrastructure from April to June 2022. A total of 252 EP personnel (42% women) participated, from 50 countries and different professional roles. Most participants expressed concerns regarding the effects of radiation on reproductive capacity (67.1%) and offspring diseases (68.2%). Only 37.9% of participants were aware of the EHRA 2017 consensus document about occupational radiation exposure. Most participants (80.9%) considered that occupational radiation during pregnancy is not safe. EP female staff were not allowed to work in the EP lab during pregnancy in 48.1% of cases. Zero-fluoroscopy was the preferred choice to continue working in the EP lab during pregnancy. CONCLUSION EP staff, including both men and women, have concerns about the effects of radiation on reproductive capacity. Despite the recommendations issued by international bodies, implementation of the policies regarding pregnancy and occupational radiation exposure is heterogeneous. Zero-fluoroscopy is the preferred approach to ensure safety during pregnancy in the EP lab.
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Affiliation(s)
- Raquel Adeliño
- Arrhythmia Unit, Cardiology Department, Vall d’Hebron University Hospital, Pg. de la Vall d'Hebron 119, 08035 Barcelona, Spain
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | | | - Laura Perrotta
- Arrhythmia Unit, Department of Cardiothoracovascular Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Martina Nesti
- Arrhythmia Unit, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, 56124 Pisa, Italy
| | - Emilia-Violeta Goanță
- Cardiology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 2 Eftimie Murgu 2, Timisoara 300041, Romania
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08025 Barcelona, Spain
- Universidad Autonoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Vilana nº 12, 08022 Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Im Prüfling 23, 60389 Frankfurt am Main, Germany
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Anselmino M, Marcantoni L, Agresta A, Chieffo E, Floris R, Racheli M, Zingarini G, De Ruvo E. Reply to Letter to the Editor: Interventional cardiology and radiograph exposure of the head: do not forget to block scatter radiation. J Cardiovasc Med (Hagerstown) 2022; 23:821-822. [PMID: 36349948 DOI: 10.2459/jcm.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Anselmino M, Marcantoni L, Agresta A, Chieffo E, Floris R, Racheli M, Zingarini G, De Ruvo E. Interventional cardiology and X-ray exposure of the head: overview of clinical evidence and practical implications. J Cardiovasc Med (Hagerstown) 2022; 23:353-358. [PMID: 34580253 DOI: 10.2459/jcm.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interventional cardiologists are significantly exposed to X- rays and no dose of radiation may be considered well tolerated or harmless. Leaded aprons protect the trunk and the thyroid gland, leaded glasses protect the eyes. The operator's legs, arms, neck and head are, instead, not fully protected. In fact, the operator's brain remains the closest part to the primary X-ray beam and scatter in most interventional procedures and specifically the physician's front head is the most exposed region during device implantation performed at the patient's side. After the initial description of cases of brain and neck tumours, additional reports on head and neck malignancies have been published. Although a direct link between operator radiation exposure and brain cancer has not been established, these reports have heightened awareness of a potential association. The use of lead-based cranial dedicated shields may help reduce operator exposure but upward scattered radiation, weight and poor tolerability have raised concerns and hindered widespread acceptance. The purpose of this review is to describe current knowledge on occupational X-ray exposure of interventional cardiologists, with a special focus on the potential risks for the head and neck and efficacy of available protection devices.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Rovigo General Hospital, Rovigo
| | | | | | - Roberto Floris
- Division of Cardiology, Ospedale di Nostra Signora di Bonaria, San Gavino Monreale
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Troisi F, Guida P, Quadrini F, Di Monaco A, Vitulano N, Caruso R, Orfino R, Cecere G, Anselmino M, Grimaldi M. Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center. Front Cardiovasc Med 2022; 9:804424. [PMID: 35571172 PMCID: PMC9095839 DOI: 10.3389/fcvm.2022.804424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Awareness of radiation exposure risks associated to interventional cardiology procedures is growing. The availability of new technologies in electrophysiology laboratories has reduced fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety, and short-term efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable. Methods Cardiac catheter ablations performed in our hospital since January 2017 to June 2021. Results A total of 1,853 procedures were performed with 1,957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% in 2017 to 22.9% of first semester 2021. The most frequent arrhythmia treated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless), and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence procedure duration. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and no different with or without fluoroscopy (0.45 vs. 0.35%). Conclusion Limiting the use of X-Rays is necessary, especially when the available technologies allow a zero-use approach. A lower radiation exposure may be reached, reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility, and efficacy.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Pietro Guida
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rosa Caruso
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rocco Orfino
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Giacomo Cecere
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
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