Abstract 17014: Getting to Zero: Impact of Electroanatomical Mapping on Fluoroscopy Use in Pediatric Catheter Ablation
Introduction: Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children’s hospital.
Methods: All patients that underwent EP and ablation procedures between January 2012 and November 2014 were included; demographic information, fluoroscopy time in minutes (FT), total radiation dose in mGy (RAD), and dose-area product in μGy/m2 (DAP) were collected. Patients were stratified by time period (before vs. after C3 introduction), structural group (normal heart, congenital heart disease (CHD), and those with normal cardiac anatomy requiring trans-septal (TS) access), and arrhythmia diagnosis (Accessory Pathway (AP), AV Nodal Reentry Tachycardia (AVNRT), atrial, or ventricular arrhythmia). Mean values were compared using a single sample t-test, as well as analysis of covariance to control for age, weight, and arrhythmia diagnosis.
Results: Mean FT decreased after the introduction of C3 in patients with normal hearts (p<0.001), AP (p<0.001), AVNRT (p=0.002), and CHD (p=0.007). After controlling for age, weight, and arrhythmia diagnosis, there was a statistically significant decrease in FT in all three groups (normal heart, CHD and TS), in RAD in the TS group, and in DAP in both the normal heart and TS groups. In all other groups, there was a trend towards decreased RAD and DAP, but they did not reach statistical significance. After the introduction of C3, zero fluoroscopy was achieved in 18/66 (27%) and ≤ 1 minute of FT in 28/66 (42%) of ablation procedures in patients with normal hearts.
Conclusions: We have shown a decrease in all metrics that measure radiation exposure when comparing the time periods before and after the introduction of C3, secondary to reducing fluoroscopy time, fluoroscopic pulse rate and radiation dose per pulse. Further refinements are still needed to decrease radiation exposure towards the goal of zero fluoroscopy, but this cannot be achieved without thinking beyond fluoroscopy time.
Author Disclosures: B.C. Clark: None. K. Sumihara: None. R. McCarter: None. C.I. Berul: None. J.P. Moak: None.
- © 2015 by American Heart Association, Inc.