P6551Evaluation of a new ultra low-dose radiation protocol during electrophysiological device implantation

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Eichenlaub, M, Astheimer, K, Restle, C, Maring, C, Blum, T, Minners, J, Schweitzer, S, Thiel, U, Neumann, F.-J, Arentz, T, Lehrmann, H
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Implantable Cardioverter / Defibrillator
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz746.1141

Abstract
Objectives
The aim of this study was to evaluate the impact of a new ultra low-dose radiation protocol on radiation doses, feasibility and safety during electrophysiological device implantation.
Background
Radiation is one of the main hazards during electrophysiological procedures. Shielding is especially difficult during device implantation and particularly implantation of cardiac resynchronisation therapy devices (CRT) is associated with high radiation doses.
Methods
From January 2005 to January 2019, 8612 patients underwent de novo device implantation at our University Heart Center.
During 2018, we established a new ultra low-dose radiation protocol and compared 661 patients who were treated during 2017 utilizing the conventional low-dose protocol with 512 patients after the application of the new program (11.5% one-chamber devices, 68.5% two-chamber devices and 19.9% CRT).
Results
After establishment of the radiation reduction protocol, dose area products could be reduced by 62% and the effective doses by 59% (113 (47–292) vs. 43 (14–130) cGycm2, p<0.0001 and 0.25 (0.11–0.63) vs. 0.10 (0.03–0.28) mSv, p<0.0001). These results could be achieved without prolonging procedure time, increasing complication and decreasing success rate.
Male gender, higher BMI, longer procedure and fluoroscopy duration and the use of the conventional radiation protocol were statistically significant factors for the need of higher radiation doses in multivariate regression analysis.
Clinical and procedural characteristics
All (n=1173)
Group pre (n=661)
Group post (n=512)
P
Age, years
77 (69–82)
77 (69–82)
77 (69–83)
0.6
Male, n (%)
726 (62)
403 (61)
323 (63)
0.5
Body mass index, kg/m2
26.6 (24–29.8)
26.6 (24–29.8)
26.4 (24–29.4)
0.5
Procedure time, minutes
35 (25–50)
37 (26–50)
35 (25–54.5)
0.5
Fluoroscopy time, minutes
3.7 (2–7.8)
4 (2–7.8)
3.4 (1.9–7.7)
0.07
Dose area product, cGy cm2
80 (28–228)
113 (47–292)
43 (14–130)
<0.0001
Effective dose, mSv
0.18 (0.06–0.51)
0.25 (0.11–0.63)
0.1 (0.03–0.28)
<0.0001
Complications, n (%)
11 (0.9)
7 (1.1)
4 (0.8)
0.8
Conclusions
Radiation exposure during electrophysiological device implantation has been continuously reduced over the last years. By establishing a new ultra low-dose radiation protocol, we could further decrease the radiation dose significantly and reach the lowest radiation values published so far. This protocol can easily be implemented in the workflow of other hospitals and should become standard during implantation procedures.