title: Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with "ALARA" principles profoundly lowers total dose.
abstract: BACKGROUND
  "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose.
  
  
  METHODS
  From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2-3 frames/second), low fluoro dose/frame (6-18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with "fast anatomical mapping" (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols.
  
  
  RESULTS
  A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical-fluoroscopy technique.
  
  
  CONCLUSIONS
  Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.
authors.affiliation: Pediatric Arrhythmia Service,Division of Pediatric Cardiology,Department of Pediatrics,Albert Einstein College of Medicine,The Children's Hospital at Montefiore,Bronx,New York,United States of America.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
authors.affiliation: Pediatric Arrhythmia Service,Division of Pediatric Cardiology,Department of Pediatrics,Albert Einstein College of Medicine,The Children's Hospital at Montefiore,Bronx,New York,United States of America.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Gates
authors.affiliation: Pediatric Arrhythmia Service,Division of Pediatric Cardiology,Department of Pediatrics,Albert Einstein College of Medicine,The Children's Hospital at Montefiore,Bronx,New York,United States of America.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Gellis
authors.affiliation: Pediatric Arrhythmia Service,Division of Pediatric Cardiology,Department of Pediatrics,Albert Einstein College of Medicine,The Children's Hospital at Montefiore,Bronx,New York,United States of America.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nappo
authors.affiliation: Pediatric Arrhythmia Service,Division of Pediatric Cardiology,Department of Pediatrics,Albert Einstein College of Medicine,The Children's Hospital at Montefiore,Bronx,New York,United States of America.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
mesh_terms: D000293:Adolescent; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects; D011874:Radiometry / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Paediatric; ablation; radiation; supraventricular tachycardia