Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Internal Medicine and Cardiology, German Heart Center, Augustenburger Platz 1, 13353 Berlin, Germany.
Europace. 2018 Apr 1;20(4):604-607. doi: 10.1093/europace/eux010.
Despite the use of 3D mapping systems and new developments of non-fluoroscopic options, most centres still rely at least in part on fluoroscopy for catheter visualization during catheter ablations. The purpose of this study was to assess the feasibility of using an ultra-low frame rate and antiscatter grid-less radiation protocol during complex left atrial ablations to minimize radiation exposure for the patient and staff.
A total of 150 consecutive patients undergoing left atrial ablations in our hospital were included in the analysis. The procedures were performed between January 2015 and November 2016. Of the included patients 75 (50%) underwent ablation before and 75 (50%) after the ultra-low frame rate (reduced from 4 to 2 FPS) and antiscatter grid-less radiation protocol was established. Procedures performed after the dose reduction protocol was established showed a 64% reduction of the dose area product (630.28 ± 550.96 vs. 226.44 ± 277.44 µGym2, P < 0.001), while fluoroscopy duration (14.22 ± 4.47 vs. 13.62 ± 7.11 min, P = 0.066) and procedural duration (1:48 ± 0:28 vs. 1:53 ± 0:34 min, P = 0.525) were not prolonged. Acute procedural success was achieved in all procedures. Two complications occurred before and one complication after the protocol was established. During four procedures, operators decided to re-introduce the antiscatter grid. This was due to impaired visibility in morbidly obese patients (n = 2) or technically difficult transseptal puncture (n = 2).
The use of an ultra low framerate and antiscatter grid-less radiation protocol effectively reduced radiation dose for complex left atrial ablation procedures and lead to very low average patient doses. Reduced image quality did not impair procedural and fluoroscopy duration or acute procedural success.
尽管使用了 3D 绘图系统和非透视选择的新进展，大多数中心在导管消融期间仍至少部分依赖于透视来可视化导管。本研究的目的是评估在复杂左心房消融过程中使用超低帧率和无散射格栅辐射方案的可行性，以最大程度地减少患者和医务人员的辐射暴露。
本研究共纳入了 150 例在我院接受左心房消融的连续患者。这些程序是在 2015 年 1 月至 2016 年 11 月期间进行的。在包括的患者中，75 例（50％）在建立超低帧率（从 4 降低至 2 FPS）和无散射格栅辐射方案之前进行了消融，75 例（50％）在之后进行了消融。在剂量减少方案实施后进行的手术显示剂量面积乘积降低了 64％（630.28 ± 550.96 对 226.44 ± 277.44 µGym2，P < 0.001），而透视时间（14.22 ± 4.47 对 13.62 ± 7.11 分钟，P = 0.066）和手术时间（1:48 ± 0:28 对 1:53 ± 0:34 分钟，P = 0.525）没有延长。所有手术均获得急性手术成功。方案实施前后各发生 2 例并发症，实施后发生 1 例并发症。在 4 次手术中，操作者决定重新引入散射格栅。这是由于病态肥胖患者的可视性受损（n = 2）或技术上困难的经间隔穿刺（n = 2）所致。
使用超低帧率和无散射格栅辐射方案可有效降低复杂左心房消融术的辐射剂量，并导致患者平均剂量极低。图像质量降低并未影响手术和透视时间或急性手术成功率。
