title: Reduction in radiation dose for atrial fibrillation ablation over time: A 12-year single-center experience of 2344 patients.
abstract: Pulmonary vein isolation (PVI) is a well-established treatment of atrial fibrillation (AF), with contact force (CF)-sensing catheters joining 3-dimensional mapping systems and image integration as technological advancements over the last decade.
  
  
  
  The purpose of this study was to analyze trends in radiation exposure for AF ablation over the last 12 years at our center.
  
  
  
  We reviewed prospectively collected data of 2344 consecutive PVI procedures for either paroxysmal or persistent AF between January 2004 and December 2015. During this period, all cases used 3-dimensional mapping systems, with 8 software and 2 hardware upgrades. Primary endpoints were fluoroscopy time, absorbed dose (Air Kerma in mGy), and effective dose (mSv).
  
  
  
  In total, 1914 patients underwent initial PVI, and 430 patients underwent redo PVI using radiofrequency energy. Fluoroscopy time, and absorbed and effective doses significantly and progressively decreased over the 12-year period for initial PVI as follows: 2004-2006: 61 ± 27 minutes; 2007-2009: 46 ± 14 minutes, 1365 ± 1369 mGy, 11.3 ± 12.5 mSv; 2010-2012: 31 ± 11, 464 ± 339 mGy, 9.0 ± 10.4 mSv; and 2013-2015: 17 ± 9 minutes, 304 ± 758 mGy, 5.5 ± 6.7 mSv. CF-sensing catheters were used for 357/508 PVI only cases between 2014 and 2015. Fluoroscopy times (11 ± 5 vs 21 ± 8 minutes; P <.001) and absorbed dose (200 ± 524 vs 470 ± 1326 mGy; P = .004) were significantly shorter with this catheter.
  
  
  
  Radiation exposure has dramatically decreased over the last decade for PVI and is related to operator experience, annual case volume, technology evolution, and more recently CF-sensing catheters. This has significant implications for both patient and operator long-term risk.
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Voskoboinik
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Elana S
authors.initials: ES
authors.lastname: Kalman
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Savicky
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: Jon.Kalman@mh.org.au.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D005500:Follow-Up Studies; D005544:Forecasting; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology
keywords: Ablation; Atrial fibrillation; Contact force; Fluoroscopy; Radiation