title: Reduction of radiation exposure during ablation of atrial fibrillation.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) during ablation of atrial fibrillation (Afib) may be associated with long fluoroscopy duration. Although most current publications report on fluoroscopy time (FT), the dose-area product (DAP) may be a more valuable parameter for depicting radiation exposure. The aim of our study was to describe a method to reduce DAP by simple means during ablation of Afib.
  
  
  METHODS
  Patients undergoing Afib ablation using a three-dimensional (3D) mapping system were assigned to two fluoroscopy protocols: (1) standard settings with 7.5 pictures/s and collimation to the heart, fluoroscopy as needed for the convenience of the operator (standard group, SG); and (2) strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal orientation by the 3D mapping system (redDAP group). The primary endpoint was DAP.
  
  
  RESULTS
  The study comprised 206 patients, who were assigned to the SG (n = 101, 49 %) or to the redDAP group (n = 105, 51 %). Mean FT was significantly reduced from 29.9 ± 11.3 min (SG) to 13.3 ± 8.3 min (redDAP group); mean DAP was reduced by approximately 90 % from 8,690 ± 5,727 to 837 ± 647 cGycm(2). The groups did not differ significantly in body mass index (28.8 ± 4.1 vs. 29.0 ± 5.0). PVI could be achieved in 98 of 101 patients (97 %) from the SG group and in all patients (100 %) from the redDAP group. Procedure time was significantly longer in the redDAP group (160.9 ± 35.7 vs. 138.1 ± 34.3 min).
  
  
  CONCLUSIONS
  Radiation exposure during Afib ablation procedures can be reduced with simple means by strict collimation to the left atrium, a frame rate of 4 pictures/s, shortened pulmonary vein angiography sequences, and maximal 3D orientation.
authors.affiliation: Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany. ralph.schneider@med.uni-rostock.de.
authors.forename: Ralph
authors.initials: R
authors.lastname: Schneider
authors.affiliation: Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Lauschke
authors.affiliation: Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
authors.forename: Cindy
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Tischer
authors.affiliation: Institute for Biostatistics and Informatics in Medicine, University Rostock, Rostock, Germany.
authors.forename: Aenne
authors.initials: A
authors.lastname: Glass
authors.affiliation: Heart Centre, University Clinic, University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bänsch
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D010690:Phlebography / Q000379:methods*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D000069079:Radiation Exposure / Q000032:analysis / Q000517:prevention & control*; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
keywords: Atrial fibrillation; Dose–area product; Fluoroscopy time; Radiofrequency ablation; Three-dimensional electro-anatomical reconstruction