Pass Robert H, Gates Gregory G, Gellis Laura A, Nappo Lynn, Ceresnak Scott R
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.
Cardiol Young. 2015 Jun;25(5):963-8. doi: 10.1017/S1047951114001474. Epub 2014 Aug 26.
"ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose.
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.
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.
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.
“尽可能合理达到最低水平（ALARA）”方案可降低患者辐射剂量。添加电解剖标测可能会进一步降低剂量。
从2011年6月至2012年4月，一种新的ALARA方案应用于所有接受室上性心动过速消融的患者，包括低帧率（2 - 3帧/秒）、低荧光透视剂量/帧（6 - 18纳戈瑞/帧）以及其他减少荧光透视的技术（ALARA）。从2012年6月至2013年3月，在ALARA方案中增加使用带有“快速解剖标测”功能的CARTO® 3（C3）（ALARA + C3）。未使用血管内超声。对两种方案的人口统计学、手术和辐射数据进行分析和比较。
共纳入75例患者：42例采用ALARA方案的患者和33例采用ALARA + C3方案的患者。两组患者的人口统计学特征相似。ALARA方案组的急性成功率为95%，ALARA + C3方案组为100%；未观察到与导管插入术相关的并发症。ALARA组的手术时间为125.7分钟，而ALARA + C3组为131.4分钟（p = 0.36）。ALARA + C3组的辐射剂量显著更低，ALARA + C3组的平均空气比释动能为13.1±28.3毫戈瑞（标准差），而ALARA组为93.8±112毫戈瑞（p < 0.001）。ALARA + C3组的平均剂量面积乘积为92.2±179微戈瑞·平方米，而ALARA组为584±687微戈瑞·平方米（p < 0.001）。在ALARA + C3组的33名受试者（42%）中，14名受试者的暴露剂量≤1毫戈瑞。ALARA + C3方案的剂量是已报道的联合电解剖 - 荧光透视技术中最低的。
在ALARA方案中添加CARTO® 3可显著降低接受室上性心动过速消融的年轻人的辐射暴露，同时保证手术疗效和安全性相当。
