Scanavacca M, d'Avila A, Velarde J L, Reolão J B, Sosa E
Heart Institute, University of São Paulo Medical School, Brazil.
Int J Cardiol. 1998 Jan 5;63(1):71-4. doi: 10.1016/s0167-5273(97)00278-7.
Prolonged exposure to radiation during radiofrequency catheter ablation implies a potential risk of radiodermatitis, neoplasm and genetic defects to the patient and to the operator-physician. The use of pulsed fluoroscopy is thought to reduce such a risk because the radiation dose decreases for the same period of time. The aim of the present study was to compare the radiation exposure time during pulse and continuous radiofrequency catheter ablation.
Procedures were divided according to the sort of fluoroscopy utilized and the last four cases of atrioventricular (AV) junction ablation, four of atrial flutter, five of atrial tachycardia, 16 of AV node reentrant tachycardia, 16 of AV tachycardia and 10 of ventricular tachycardia in which pulsed and continuous fluoroscopy were utilized were respectively separated into Group I (pulse fluoroscopy) and Group II (continuous fluoroscopy) with 55 patients in each group. Fluoroscopy was generated by the same device in the two groups. Continuous fluoroscopy used 2 mA and automatic kV adjustment (automatic brightness stabilizer) ranging from 70 to 110 kV. Pulsed fluoroscopy was set at 7 squares/s with 25 mA and automatic kV adjustment. Fluoroscopy time was registered by the fluoroscopy device counter.
Procedure duration, success rate and complications did not differ between Groups I and II. Fluoroscopy time, however, was 4.4+/-4 min during pulsed fluoroscopy and 27+/-23 min during continuous fluoroscopy (p=0.001).
During radiofrequency catheter ablation procedures, the use of pulsed fluoroscopy set at 7 squares/s, decreases the radiation exposure time by 80% as compared to continuous fluoroscopy without changing procedure duration and success rate.
在射频导管消融过程中长时间暴露于辐射下，对患者和操作医师意味着有发生放射性皮炎、肿瘤和基因缺陷的潜在风险。使用脉冲透视被认为可降低这种风险，因为在相同时间段内辐射剂量会降低。本研究的目的是比较脉冲和连续射频导管消融过程中的辐射暴露时间。
根据所使用的透视类型对手术进行分组，将最后4例房室（AV）结消融、4例心房扑动、5例房性心动过速、16例房室结折返性心动过速、16例房室性心动过速和10例室性心动过速中使用脉冲和连续透视的病例分别分为I组（脉冲透视）和II组（连续透视），每组55例患者。两组使用同一设备产生透视。连续透视使用2毫安和70至110千伏的自动千伏调节（自动亮度稳定器）。脉冲透视设置为每秒7格，25毫安和自动千伏调节。透视时间由透视设备计数器记录。
I组和II组之间的手术持续时间、成功率和并发症无差异。然而，脉冲透视时的透视时间为4.4±4分钟，连续透视时为27±23分钟（p = 0.001）。
在射频导管消融手术过程中，设置为每秒7格的脉冲透视与连续透视相比，在不改变手术持续时间和成功率的情况下，可将辐射暴露时间减少80%。
