Voskoboinik Aleksandr, Kalman Elana S, Savicky Yonatan, Sparks Paul B, Morton Joseph B, Lee Geoffrey, Kistler Peter M, Kalman Jonathan M
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia.
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Heart Rhythm. 2017 Jun;14(6):810-816. doi: 10.1016/j.hrthm.2017.02.014. Epub 2017 Feb 12.
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.
肺静脉隔离（PVI）是一种成熟的心房颤动（AF）治疗方法，在过去十年中，接触力（CF）感知导管与三维标测系统及图像整合技术共同发展。
本研究旨在分析我院过去12年中AF消融术辐射暴露的趋势。
我们回顾性分析了2004年1月至2015年12月期间连续2344例阵发性或持续性AF患者接受PVI手术的前瞻性收集数据。在此期间，所有病例均使用三维标测系统，软件进行了8次升级，硬件进行了2次升级。主要终点为透视时间、吸收剂量（空气比释动能，单位为mGy）和有效剂量（单位为mSv）。
共有1914例患者接受了初次PVI，430例患者接受了射频能量的再次PVI。在12年期间，初次PVI的透视时间、吸收剂量和有效剂量均显著且逐渐下降，具体如下：2004 - 2006年：61±27分钟；2007 - 2009年：46±14分钟，1365±1369 mGy，11.3±12.5 mSv；2010 - 2012年：31±11分钟，464±339 mGy，9.0±10.4 mSv；2013 - 2015年：17±9分钟，304±758 mGy，5.5±6.7 mSv。2014年至2015年期间，357/508例单纯PVI病例使用了CF感知导管。使用该导管时，透视时间（11±5分钟 vs 21±8分钟；P<.001）和吸收剂量（200±524 mGy vs 470±1326 mGy；P = .004）显著缩短。
在过去十年中，PVI的辐射暴露显著降低，这与术者经验、年手术量、技术发展以及最近的CF感知导管有关。这对患者和术者的长期风险具有重要意义。
