232Accessory pathway ablation in adults: estimated additional cancer risk depending on the mapping and ablation strategy

Abstract

Abstract Introduction Catheter ablation is the treatment of choice for accessory pathways (AP) in high risk patients and it´s usually performed under fluoroscopy guidance (reported X-Ray time:16 -38min).Radiation exposure is associated with an increased incidence of dermatitis,gene defects, cataract and malignancy.3-D mapping systems(EAMS) can reduce fluoroscopy exposure. Purpose To evaluate the additional cancer risk throughout life in 2 homogeneous adult populations of high-risk APs treated either with conventional fluoroscopically guided ablation (CFA) or with an EAM- and echocardiography(TEE or ICE)guided minimally fluoroscopic ablation approach (MFA).Methods: 2 Center study, 60 consecutive pts enrolled; 31pts underwent CFA at IRCCS Policlinico san Matteo (Pavia) and 29 pts underwent EAM guided MFA at Klinikum Fuerth between 01/2016 and 09/2019.The age and gender-adjusted cancer risk was calculated following Monte Carlo code,according to Biological Effects of Ionizing Radiation (BEIR VII) empirical risk models. Results The estimated additional cancer risk throughout life gained with a single ablation procedure was significatively different between groups:0.18% in CFA compared to 0.001% in MFA group(P < 0.001).The maximum estimated additional cancer risk for a patient undergoing CFA was 1%.10 out of 29 MFA procedures(35%)were successfully performed with zero fluoroscopy. Conclusions:Our small study demonstrates that an echocardiography/EAM guided approach allows safe AP ablation adding a significantly reduced estimated cancer risk compared to CFA in young adults,a population sensitive to X-ray exposure regarding the stochastic risk of developing malignancies.This finding strongly supports the recommendation for a routine use of EAMS in AP ablations,including appropriate reimbursement. Results Conventional fluoroscopic approach Minimal fluoroscopic approach p Patient (N) 31 29 n.s. Age (Y) 43.7 ± 14 44.7 ± 17 n.s. Right AP 10 6 n.s. Left Ap 21 23 n.s. Transeptal Access 20 22 n.s. Complications 1 (3%) 0 n.s. DAP (µGy*m2) 15252+/-11132 56.8+/-135.6 0.000 Effective Dose (mSv) 30.35+/-27.7 0.09+/-0.28 0.000. Additional Cancer Risk 0.18% 0.001% >0.001 N, number; Y, years; AP, Accessory Pathway.