Wang F, Lu Y, Yuan C, Bai J R, Yang H S, Wu L
Catheterization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China.
Zhonghua Er Ke Za Zhi. 2017 Apr 2;55(4):272-276. doi: 10.3760/cma.j.issn.0578-1310.2017.04.008.
To evaluate the feasibility and efficiency of a low dose imaging protocol on reducing X-ray dose level in pediatric supraventricular tachycardia (SVT) ablation procedure. Data were collected from 103 patients who underwent catheter ablation for SVT in Children's Hospital of Fudan University from January 2014 to October 2016 in terms of body weight, body surface area (BSA), SVT types, accessory pathway location, fluoroscopy time and the radiation dose (including AIR KERMA and dose area product) in a case observational study.The fluoroscopy protocols were operated at 36 nGy/frame and 10 frames/s (Standard group, =47) from January 2014 to September 2015, 36 nGy/frame and 10 frames/s with removal of the grid (Grid-out group, =24) from October 2015 to April 2016, as well as 23 nGy/frame and 4.0-7.5 frames/s without the grid (Grid-out plus low dose group, =32) from May 2016 to October 2016, respectively.Comparisons among groups were performed by independent-sample -test or one-way analysis of variance for normally distributed continuous variables, and χ(2) test for categorical variables. The average body weight, BSA, fluoroscopy time and AIR KERMA of the three groups was (34±14) kg, (1.14±0.33) m(2,) (11±8) minutes and (12.97±12.43) mGy, respectively.No significant differences in body weight (=2.551), BSA (=2.359), SVT types (χ(2)=6.15), and accessory pathway location (χ(2)=3.438) were observed among these three groups (>0.05). Images acquired by low dose protocol could provide enough information for procedures, and no complication occurred.The acute success rates were 100% in all of these three groups, and there was no significant difference in mean fluoroscopy time (=0.004, >0.05) among them.However, the radiation dose (AIR KERMA) in the Grid-out plus low dose group was much lower than that in the Standard group ((7.54±7.31) mGy . (16.25±12.08) mGy, =6.112, <0.01)). The new strategy of combination of low dose fluoroscopy protocol with removal of grid markedly reduced radiation exposure to children undergoing supraventricular tachycardia ablation while maintaining procedural efficacy and safety.
评估低剂量成像方案在降低小儿室上性心动过速（SVT）消融手术中X射线剂量水平方面的可行性和效率。在一项病例观察研究中，收集了2014年1月至2016年10月在复旦大学附属儿科医院接受SVT导管消融术的103例患者的体重、体表面积（BSA）、SVT类型、旁路位置、透视时间和辐射剂量（包括空气比释动能和剂量面积乘积）等数据。2014年1月至2015年9月，透视方案以36 nGy/帧和10帧/秒运行（标准组，n = 47）；2015年10月至2016年4月，透视方案为36 nGy/帧和10帧/秒且去除滤线栅（去栅组，n = 24）；2016年5月至10月，透视方案为23 nGy/帧和4.0 - 7.5帧/秒且无滤线栅（去栅加低剂量组，n = 32）。对于正态分布的连续变量，采用独立样本t检验或单因素方差分析进行组间比较，对于分类变量采用χ²检验。三组患者的平均体重、BSA、透视时间和空气比释动能分别为（34±14）kg、（1.14±0.33）m²、（11±8）分钟和（12.97±12.43）mGy。三组患者在体重（t = 2.551）、BSA（t = 2.359）、SVT类型（χ² = 6.15）和旁路位置（χ² = 3.438）方面均未观察到显著差异（P>0.05）。低剂量方案获取的图像可为手术提供足够信息，且未发生并发症。这三组的急性成功率均为100%，且它们之间的平均透视时间无显著差异（F = 0.004，P>0.05）。然而，去栅加低剂量组的辐射剂量（空气比释动能）远低于标准组（（7.54±7.31）mGy 比（16.25±12.08）mGy，t = 6.112，P<0.01）。低剂量透视方案与去除滤线栅相结合的新策略在保持手术疗效和安全性的同时，显著降低了接受室上性心动过速消融术儿童的辐射暴露。
