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Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry

BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required f...

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Autores principales: Kosiuk, Jedrzej, Fiedler, Lucas, Ernst, Sabine, Duncker, David, Pavlović, Nikola, Guarguagli, Silvia, Stegmann, Clara, Miskowiec, Dawid, Garcia, Rodrigue, Russo, Vincenzo, Yakushev, Andriy, Szegedi, Nándor, De Potter, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803367/
https://www.ncbi.nlm.nih.gov/pubmed/33220000
http://dx.doi.org/10.1002/clc.23411
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author Kosiuk, Jedrzej
Fiedler, Lucas
Ernst, Sabine
Duncker, David
Pavlović, Nikola
Guarguagli, Silvia
Stegmann, Clara
Miskowiec, Dawid
Garcia, Rodrigue
Russo, Vincenzo
Yakushev, Andriy
Szegedi, Nándor
De Potter, Tom
author_facet Kosiuk, Jedrzej
Fiedler, Lucas
Ernst, Sabine
Duncker, David
Pavlović, Nikola
Guarguagli, Silvia
Stegmann, Clara
Miskowiec, Dawid
Garcia, Rodrigue
Russo, Vincenzo
Yakushev, Andriy
Szegedi, Nándor
De Potter, Tom
author_sort Kosiuk, Jedrzej
collection PubMed
description BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required for optimal clinical routine can be identified. METHODS: Centers participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. RESULTS: Twenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm(2), 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm(2), 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm(2), 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm(2), 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001). CONCLUSION: Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
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spelling pubmed-78033672021-01-19 Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry Kosiuk, Jedrzej Fiedler, Lucas Ernst, Sabine Duncker, David Pavlović, Nikola Guarguagli, Silvia Stegmann, Clara Miskowiec, Dawid Garcia, Rodrigue Russo, Vincenzo Yakushev, Andriy Szegedi, Nándor De Potter, Tom Clin Cardiol Clinical Investigations BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required for optimal clinical routine can be identified. METHODS: Centers participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. RESULTS: Twenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm(2), 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm(2), 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm(2), 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm(2), 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001). CONCLUSION: Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified. Wiley Periodicals, Inc. 2020-11-21 /pmc/articles/PMC7803367/ /pubmed/33220000 http://dx.doi.org/10.1002/clc.23411 Text en © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Investigations
Kosiuk, Jedrzej
Fiedler, Lucas
Ernst, Sabine
Duncker, David
Pavlović, Nikola
Guarguagli, Silvia
Stegmann, Clara
Miskowiec, Dawid
Garcia, Rodrigue
Russo, Vincenzo
Yakushev, Andriy
Szegedi, Nándor
De Potter, Tom
Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title_full Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title_fullStr Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title_full_unstemmed Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title_short Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry
title_sort fluoroscopy usage in contemporary interventional electrophysiology: insights from a european registry
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803367/
https://www.ncbi.nlm.nih.gov/pubmed/33220000
http://dx.doi.org/10.1002/clc.23411
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