Resetting the Bar to Reduce Radiation Exposure During Ablation of Cardiac Arrhythmias

Abstract

See Article by Pani et al Electrophysiology procedures are dependent on imaging technologies to position pacemaker or implantable cardioverter defibrillator leads, perform extractions, or position catheters for diagnostic studies or ablation procedures. In most cases, these procedures depend on radiological imaging, which exposes patients and medical personnel to the potential risks of radiation exposure. This has been the subject of 2 consensus documents developed by the American College of Radiology to improve safe practice during interventional procedures for coronary artery disease, valve disease, or electrophysiological studies.1,2 The emphasis of these documents has been on best practice to achieve the lowest reasonably achievable dose. These goals depend on up-to-date imaging systems, collimation of the beam, minimizing steep angulation, optimizing distance between patient and the x-ray tube and the image intensifier, and avoiding any exposure that is not necessary. There are guidelines for hospitals to ensure that their physicians have received basic training for radiation safety and know how to operate their equipment to achieve these goals.3 Because our procedures have become more complex, the need for detailed imaging has become more important. This has increased the potential risks of radiation exposure to patients and the lifetime exposure for medical personnel, which is greatest for the physicians who perform the procedure. In response to these concerns, industry has devoted substantial effort into development of electroanatomic 3-dimensional imaging systems that do not depend on radiation and new radiographic technologies that reduce our exposure to radiation. Reductions in frame rate and other measures compromise the image quality to some extent, but these parameters can be adjusted during the case to enhance the image …