Patients’ Radiation Exposure during Various Types of Cardiac Arrhythmias Ablation

Background: Cardiac Radiofrequency (RF) ablation is used for treating some types of heart rhythm problems. The number of RF ablation procedures is increasing rapidly due to lower complication risks than surgery and high success rates. Due to higher patient exposure to X-ray radiation in different cardiac ablation procedures, public concerns are increasing regarding the detrimental effects of ionizing radiation, including skin injury, genetic effects, and malignancy.
Objectives: This study aimed to determine patient absorption doses during Electrophysiological Study (EPS) and RF ablation of different cardiac arrhythmias in an electrophysiology laboratory unit with a flat panel detector.
Patients and Methods: This cross-sectional study was performed on 223 patients who underwent cardiac EPS and RF ablation. All procedures were executed on a single panel angiography unit with floor mounted C-arm. Dose Area Product (DAP), Entrance Skin Dose (ESD), and Fluoroscopy Time (FT) were recorded in all different procedures. Also, Total FT (TFT), total DAP, and total ESD were analyzed in the 223 procedures separately. Pearson’s correlation test was used to estimate the relationships between FT and DAP, FT and ESD, and ESD and DAP.
Results: In this study, 56.1% of the patients were female. The mean age of male and female patients was 43.9 and 47.7 years, respectively. Medians of TFT, total ESD, and total DAP were 7.4 min, 165 mGy, and 19.2 Gycm2, respectively. Total ESD was strongly correlated to DAP (r = 0.945, P < 0.001). Significant correlations were also observed between FT and DAP (r = 0.843, P < 0.001) and between FT and ESD (r = 0.747, P < 0.001). AF ablation procedures had the highest medians of DAP, ESD, and FT values during all types of cardiac arrhythmias.
Conclusions: For prevention of deterministic and stochastic effects of radiation exposure, such as skin damage and cancer, operators should attempt to reduce patients’ radiation exposure as low as reasonably achievable. In the current study, none of the patients’ ESDs exceeded the threshold dose. The maximum ESD and DAP values were attributed to AF ablation procedures. Significant correlations between DAP and FT as well as between ESD and FT and the strong correlation between DAP and ESD showed that ESD could be reduced by reducing FT and DAP.