Clark Bradley C, Janson Christopher M, Ceresnak Scott R, Osei Frank A, Bonney William J, Nappo Lynn, Pass Robert H
Children's Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 1 Pediatrics, Bronx, NY, 10467, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
J Interv Card Electrophysiol. 2019 Jun;55(1):93-98. doi: 10.1007/s10840-018-0479-z. Epub 2018 Nov 9.
Device implantation requires fluoroscopic guidance, which carries inherent risks of ionizing radiation. We evaluated the impact of a low-dose fluoroscopic protocol on radiation exposure during device implantation.
All patients who underwent pacemaker or ICD implantation with new transvenous leads from July 2011 to January 2018 were included. A novel ALARA protocol consisting of ultra-low frame rates (2-3 frames/s), low dose/frame (6-18 mGy/frame), and use of the "air-gap" technique in patients < 20 kg was employed. Demographics, procedural data, and radiation exposure levels were collected and analyzed.
Thirty patients underwent device implantation without additional catheterization, electrophysiology study, or ablation procedure (median age 15 years; range 5-50) with a total of 43 leads placed. Forty-seven percent of patients had a primary rhythm disturbance, 33% had cardiomyopathy, and 20% had congenital heart disease. Fifty percent were pacemakers (53% dual-chamber, 27% ventricle, 20% atrial) and 50% of devices implanted were ICDs (87% single-chamber). All implants were acutely successful with acceptable atrial and ventricular sensing and capture thresholds. The median fluoroscopy time was 11.5 min (inter-quartile range (IQR) 8.0-18.2), median air kerma dose 4.0 mGy (IQR 2.5-19.5), and median dose-area product 27.8 μGy/m (IQR 17.1-106.5). Median implant procedure time was 133 min. One patient required revision secondary to device migration without lead derangement 2 days post-procedure.
Use of a novel fluoroscopic protocol may help decrease radiation exposure to patients and staff without affecting efficacy or risk. These data may represent benchmarks against which future device implantation procedures can be compared.
设备植入需要荧光透视引导,而这存在电离辐射的固有风险。我们评估了低剂量荧光透视方案对设备植入期间辐射暴露的影响。
纳入2011年7月至2018年1月期间所有接受带有新的经静脉导线的起搏器或植入式心律转复除颤器(ICD)植入的患者。采用了一种新的尽可能降低辐射剂量(ALARA)方案,该方案包括超低帧率(2 - 3帧/秒)、低剂量/帧(6 - 18毫戈瑞/帧)以及对体重<20 kg的患者使用“气隙”技术。收集并分析了人口统计学数据、手术数据和辐射暴露水平。
30例患者在未进行额外导管插入术、电生理研究或消融手术的情况下接受了设备植入(中位年龄15岁;范围5 - 50岁),共植入43根导线。47%的患者有原发性心律失常,33%有心肌病,20%有先天性心脏病。50%为起搏器(双腔起搏器占53%,心室起搏器占27%,心房起搏器占20%),植入的设备中有50%是ICD(单腔ICD占87%)。所有植入均即刻成功,心房和心室感知及捕捉阈值可接受。荧光透视中位时间为11.5分钟(四分位间距(IQR)8.0 - 18.2),空气比释动能中位剂量为4.0毫戈瑞(IQR 2.5 - 19.5),剂量面积积中位值为27.8微戈瑞/米²(IQR 17.1 - 106.5)。植入手术中位时间为133分钟。1例患者在术后2天因设备移位但导线未紊乱而需要进行翻修。
使用新的荧光透视方案可能有助于减少患者和工作人员的辐射暴露,而不影响疗效或风险。这些数据可能代表了未来可用于比较设备植入手术的基准。