Circulation, Vol 84, 2376-2382, Copyright © 1991 by American Heart Association
H Calkins, L Niklason, J Sousa, R el-Atassi, J Langberg and F Morady
BACKGROUND. Catheter ablation of accessory atrioventricular (AV)
connections has been demonstrated to be effective in more than 85% of
patients. One of the risks of this procedure is radiation exposure during
the fluoroscopic imaging necessary to guide catheter manipulation. The
objective of the present study was to measure the radiation received by
patients and physicians during radiofrequency catheter ablation and to
estimate the resultant somatic and genetic risks. METHODS AND RESULTS.
Radiation exposure to patients and physicians was measured during attempts
at radiofrequency catheter ablation of accessory AV connections in 31
consecutive patients. Radiation exposure was measured using
thermoluminescent sensors placed on the patient and on the physician.
Somatic and genetic risks were estimated based on the radiation levels
recorded using these sensors. The durations of fluoroscopy and of the
catheter ablation procedure were recorded for each patient. Catheter
ablation was successful in 28 of 31 patients (90%). Mean +/- SD duration of
fluoroscopy was 44 +/- 40 minutes. The largest patient radiation dose was
measured over the ninth vertebral body posteriorly (median, 7.26 rem
[roentgen equivalents man]; range, 0.31-135.7 rem). Median radiation dose
to the thyroid was 0.46 rem (range, 0.06-7.26 rem), and median radiation
dose to the posterior iliac crest was 2.43 rem (range, 0.01-8.3 rem). The
greatest radiation dose to the operator was recorded at the left hand (99
mrem). Mean radiation dose to the operator's eyes was 28 mrem. CONCLUSIONS.
Radiofrequency catheter ablation of accessory AV connections may result in
significant radiation exposure to the patient and to the physician. Each
hour of fluoroscopic imaging is associated with a lifetime risk of
developing a fatal malignancy of 0.1% and a risk of a genetic defect of 20
per 1 million births. Although these risks must be recognized, they are
relatively small compared with the risks associated with alternate
approaches to management, including no therapy, antiarrhythmic drug
therapy, and surgery.
ARTICLES
Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections
University of Michigan Medical Center, Division of Cardiology, Ann Arbor 48109-0022.
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