How Much Can Systematic Use of 3D Mapping Systems Reduce X-ray Exposure During Catheter Ablation in a Standard EP Lab?

Background: 3D non-fluoroscopic mapping systems have been proposed as a useful tool for catheter ablation for many arrhythmias.

Objectives: The present study aimed to evaluate the effect of a methodical use of 3D mapping systems on the amount of X-ray exposure during catheter ablation.

Patients and Methods: Our study was conducted on 495 consecutive patients who underwent catheter ablation from January 2007 to December 2011. Since October 2008, all ablation procedures in our EP Lab have been performed using a mapping system. In this study, we compared fluoroscopy time, total X- ray exposure, and duration of each procedure. The data from Atrial Fibrillation (AF) ablations and Supra-Ventricular Tachycardia (SVT) ablations were also analyzed using unpaired non-parametric Mann-Whitney test (MW-test). Besides, Chi-square test (χ²-test) was used to evaluate the impact of mapping system development on X-ray exposure.

Results: The overall median fluoroscopy time decreased significantly by 78% in 5 years, falling from 29.2 min (95% Confidence Interval (CI) [24.3 - 37.8]) in 2007 to 6.3 min (95% CI [5.3 - 9.7]) in 2011 (MW-test, P < 0.001). Additionally, the median total X-ray exposure decreased from 58.18 Gy^*cm ² (95% CI [41.73 - 71.35]) in 2007 to 14.48 Gy^*cm ² (95% CI [9.61 - 18.26]) in 2011 (MW-test, P < 0.001). There was also a slight reduction in the duration of the procedures, 79% of which were acutely successful.

Conclusions: The systematic use of a mapping system markedly reduced fluoroscopy time and total X-ray exposure during catheter ablation. Although improvement in technology and growth in operators’ experience play a central role in radiation exposure reduction, our study showed that only daily use of mapping systems maximized the possibility of reducing exposure.