title: Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation.
abstract: OBJECTIVE
  Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children's hospital.
  
  
  METHODS
  All patients that underwent EP and ablation procedures between January 2012 and August 2015 were included; demographic information, fluoroscopy time (FT), total radiation dose (RAD), and dose-area product (DAP) were collected. Patients were stratified by time period (before vs. after C3 introduction) in three groups: (1) normal heart, (2) congenital heart disease (CHD), and (3) those requiring trans-septal (TS) access. The normal heart group was further separated by arrhythmia diagnosis (accessory pathway (AP), AV nodal reentry tachycardia (AVNRT), atrial, or ventricular arrhythmia). Mean values were compared using a single sample t test, as well as analysis of covariance to control for age, weight, and arrhythmia diagnosis.
  
  
  RESULTS
  Mean FT decreased after introduction of C3 in patients in all three patient groups (p < 0.01). When separated by arrhythmia diagnosis, FT decreased in the AP and AVNRT groups (p < 0.0001). After controlling for age, weight, and arrhythmia diagnosis, there was a statistically significant decrease in FT in all three groups and in both RAD and DAP in the normal heart group. Zero fluoroscopy was achieved in 50/159 (31 %) and ≤1 min of FT in 71/159 (45 %) of cases.
  
  
  CONCLUSIONS
  We have shown a significant decrease in multiple measures of radiation after introduction of C3. Continued refinements are needed to further decrease radiation utilization and achieve the goal of zero fluoroscopy.
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA. brclark@childrensnational.org.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Clark
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Sumihara
authors.affiliation: Division of Biostatistics and Informatics, Children's National Health System, Washington, DC, 20010, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA.
authors.forename: Charles I
authors.initials: CI
authors.lastname: Berul
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Moak
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control / Q000706:statistics & numerical data*; D011835:Radiation Protection; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: Electroanatomic mapping; Electrophysiology; Fluoroscopy; Pediatric ablation; Radiation