Lee Ji Hyun, Kim Jun, Kim Minsu, Hwang Jongmin, Hwang You Mi, Kang Joon-Won, Nam Gi-Byoung, Choi Kee-Joon, Kim You-Ho
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2017 Jun;96(24):e7200. doi: 10.1097/MD.0000000000007200.
Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups.The 4-FPS group showed higher median DAP (599.9 cGy cm; interquartile range [IR], 371.4-1337.5 cGy cm vs. 392.0 cGy cm; IR, 289.7-591.4 cGy cm; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5-34.9 min vs. 15.1 min; IR, 10.7-20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7-2.5 mSv vs. 0.7 mSv; IR, 0.6-1.1 mSv; P < .01) compared with the 2-FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan-Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25).In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional fluoroscopy setting.
尽管三维（3D）标测技术有所进步，但心房颤动（AF）导管消融术中的辐射暴露仍是患者和医生共同关注的主要问题。既往研究报道，在3D标测系统引导下，房颤导管消融术在每秒7.5帧（FPS）的透视设置下会产生大量辐射暴露（7369 - 8690 cGy cm）。我们评估了低帧率透视方案用于房颤导管消融的有效性和安全性。
对2014年1月至2015年5月在我院接受3D电解剖标测房颤导管消融术的133例患者的数据进行回顾性分析。自2014年1月起，我院将透视帧率设定为4 - FPS，2014年9月进一步降至2 - FPS。我们比较了4 - FPS组（n = 57）和2 - FPS组（n = 76）之间以剂量面积乘积（DAP）和有效剂量（ED）量化的辐射暴露情况。
与2 - FPS组相比，4 - FPS组的DAP中位数更高（599.9 cGy cm；四分位数间距[IR]，371.4 - 1337.5 cGy cm vs. 392.0 cGy cm；IR，289.7 - 591.4 cGy cm；P <.01），透视时间中位数更长（24.4 分钟；IR，17.5 - 34.9分钟 vs. 15.1分钟；IR，10.7 - 20.1分钟；P <.01），ED中位数更高（1.1 mSv；IR，0.7 - 2.5 mSv vs. 0.7 mSv；IR，0.6 - 1.1 mSv；P <.01）。两组均未观察到诸如心脏压塞等与手术相关的严重并发症。在331 ± 197天的随访期间，4 - FPS组有20例患者（35.1%）复发房性快速性心律失常，2 - FPS组有27例患者（35.5%）复发（P =.96）。Kaplan - Meier生存分析显示两组之间无显著差异（对数秩，P =.25）。
总之，与传统透视设置下历史报道的DAP相比，4 - FPS和2 - FPS设置都是可行的，且辐射水平相对较低。
