Published Online
on October 25, 2004

A more recent version of this article appeared on November 9, 2004

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Submitted on March 23, 2004
Revised on June 16, 2004
Accepted on June 17, 2004

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

Lars Lickfett MD, Mahadevappa Mahesh MS, PhD^*, Chandra Vasamreddy MD, David Bradley MD, Vinod Jayam MD, Zayd Eldadah MD, Timm Dickfeld MD, Deborah Kearney RT, Darshan Dalal MD, MPH, Berndt Lüderitz MD, Ronald Berger MD, PhD, and Hugh Calkins MD

From the Division of Cardiology (L.L., C.V., D.B., V.J., Z.E., T.D., D.D., R.B., H.C.) and the Department of Radiology and Radiological Science (M.M., D.K.), The Johns Hopkins Hospital, Baltimore, Md, and the Department of Medicine-Cardiology, University of Bonn, Bonn, Germany (L.L., B.L.).

^* To whom correspondence should be addressed. E-mail: mmahesh{at}jhmi.edu.

Background--The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation (AF) using the pulmonary vein (PV) approach.

Methods and Results--The study included 15 patients with AF and 5 patients each with atrial flutter and atrioventricular nodal reentrant tachycardia (AVNRT) who underwent fluoroscopically guided procedures on a biplane x-ray system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Radiation exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TLDs). Peak skin doses (PSDs), effective radiation doses, and risk of fatal malignancies were all computed. Mean fluoroscopy durations for AF procedures were 67.8±21 minutes in the right anterior oblique (RAO) and 61.9±16.6 minutes in the left anterior oblique (LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0±0.5 Gy in the RAO and 1.5±0.4 Gy in the LAO projection. The lifetime risk of excess fatal malignancies normalized to 60 minutes of fluoroscopy was 0.07% for women and 0.1% for men.

Conclusions--The relatively small amounts of the patient’s radiation exposure in this study, despite the prolonged fluoroscopy durations, can be attributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of magnification, and optimal adjustments of the fluoroscopy exposure rates. The resulting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.

Key words: catheter ablation • radiography • radiation

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