Riche Maya, Monfraix Sylvie, Balduyck Sebastien, Voglimacci-Stephanopoli Quentin, Rollin Anne, Mondoly Pierre, Mandel Franck, Beneyto Maxime, Delasnerie Hubert, Derval Nicolas, Thambo Jean Benoit, Karsenty Clement, Dulac Yves, Acar Philippe, Mora Stéphanie, Gautier Romain, Sacher Frederic, Maury Philippe
Department of cardiology, university hospital Rangueil, Toulouse, France.
Unité de radiophysique et radioprotection, university hospital, Toulouse, France.
Arch Cardiovasc Dis. 2022 Mar;115(3):151-159. doi: 10.1016/j.acvd.2022.02.001. Epub 2022 Feb 22.
Catheter ablation (CA) in children using fluoroscopy carries risks inherent to ionizing radiation exposure.
The objective of this study was to demonstrate the feasibility of using low frames rate during ablation in children to maximally decrease radiation dose.
Hundred sixty eight successive patients<18 years of age undergoing CA performed under a 3.75 frames/second rate were retrospectively included. Demographics, procedural and dosimetry data were analysed. The effective dose (ED) was evaluated in a subgroup of 14 patients.
Median age and weight were 15 years and 54kg, 72% had WPW, 10% AV node reentrant tachycardia, 10% ventricular tachycardia (atrial tachycardia, flutter and atrial fibrillation for the other cases). Acute success was achieved in 98.5% without any complication. Median procedure and fluoroscopy duration were 120 and 16minutes. Median Dose Area Product (DAP) and Air Kerma were 2.46Gy.cm and 18 mGy respectively (2Gy.cm and 15 mGy for WPW ablation). A significant reduction of median DAP was noted over the years for WPW, from 3.1Gy.cm in 2011 to 1.4 in 2019. Median estimated ED was 0.19 mSv (0.03 to 1.64), falling into the range of yearly normal natural irradiation or caused by leasure or professional activity.
Low frame rate fluoroscopy is a highly effective and safe approach in decreasing radiation exposure during CA in children without altering the success rate of the procedure. ED is low, similar to natural/leisure irradiation. This approach can be considered a good alternative to 3D-based procedures in terms of efficiency and radiation issues, at least for WPW ablations.
儿童使用荧光透视进行导管消融（CA）存在电离辐射暴露的固有风险。
本研究的目的是证明在儿童消融过程中使用低帧率以最大程度降低辐射剂量的可行性。
回顾性纳入168例18岁以下接受CA且帧率为3.75帧/秒的连续患者。分析人口统计学、手术和剂量测定数据。在14例患者的亚组中评估有效剂量（ED）。
中位年龄和体重分别为15岁和54千克，72%患有预激综合征（WPW），10%为房室结折返性心动过速，10%为室性心动过速（其他病例为房性心动过速、心房扑动和心房颤动）。98.5%的患者获得急性成功且无任何并发症。中位手术时间和透视时间分别为120分钟和16分钟。中位剂量面积乘积（DAP）和空气比释动能分别为2.46Gy·cm和18mGy（WPW消融时为2Gy·cm和15mGy）。多年来，WPW的中位DAP显著降低，从2011年的3.1Gy·cm降至2019年的1.4。中位估计ED为0.19mSv（0.03至1.64），处于年度正常自然辐射范围内或由休闲或职业活动引起。
低帧率荧光透视是一种在不改变手术成功率的情况下，有效且安全地降低儿童CA期间辐射暴露的方法。ED较低，类似于自然/休闲辐射。就效率和辐射问题而言，至少对于WPW消融，这种方法可被视为基于三维手术的良好替代方案。
