Clark Bradley C, Sumihara Kohei, McCarter Robert, Berul Charles I, Moak Jeffrey P
Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, WW 3.0, Washington, DC, 20010, USA.
Division of Biostatistics and Informatics, Children's National Health System, Washington, DC, 20010, USA.
J Interv Card Electrophysiol. 2016 Aug;46(2):183-9. doi: 10.1007/s10840-016-0099-4. Epub 2016 Jan 15.
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.
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.
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.
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.
在过去几年中，已开发出包括CARTO®3（C3）等电解剖标测系统在内的替代成像技术，以提高解剖分辨率，并有可能在电生理（EP）手术中限制辐射暴露。我们回顾性研究了在一家儿童医院引入C3对EP研究和消融手术期间患者辐射暴露的影响。
纳入2012年1月至2015年8月期间接受EP和消融手术的所有患者；收集人口统计学信息、透视时间（FT）、总辐射剂量（RAD）和剂量面积乘积（DAP）。患者按时间段（引入C3之前与之后）分为三组：（1）正常心脏，（2）先天性心脏病（CHD），以及（3）需要经房间隔（TS）通路的患者。正常心脏组根据心律失常诊断（旁路（AP）、房室结折返性心动过速（AVNRT）、房性或室性心律失常）进一步细分。使用单样本t检验以及协方差分析来比较平均值，以控制年龄、体重和心律失常诊断。
在所有三个患者组中，引入C3后患者的平均FT均下降（p < 0.01）。按心律失常诊断细分时，AP组和AVNRT组的FT下降（p < 0.0001）。在控制年龄、体重和心律失常诊断后，所有三组的FT均有统计学显著下降，正常心脏组的RAD和DAP也有下降。50/159（31%）的病例实现了零透视，71/159（45%）的病例FT≤1分钟。
我们已表明引入C3后多项辐射指标显著下降。需要持续改进以进一步降低辐射利用率并实现零透视目标。
