Background -The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation(AF) using the pulmonary vein(PV ) approach. Methods and Results -The study included 15 pati...Background -The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation(AF) using the pulmonary vein(PV ) approach. Methods and Results -The study included 15 patients with AF and 5 p atients each with atrial flutter and atrioventricular nodal reentrant tachycardi a(AVNRT) who underwent fluoroscopically guided procedures on a biplane X-ray sy stem operated at a low-frame pulsed fluoroscopy(7.5 frames per second). Radiati on exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TL Ds). Peak skin doses(PSDs), effective radiation doses, and risk of fatal maligna ncies were all computed. Mean fluoroscopy durations for AF procedures were 67.8 ±21 minutes in the right anterior oblique(RAO) and 61.9±16.6 minutes in the le ft anterior oblique(LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0±0.5 Gyinthe RAO and 1.5±0.4 Gy in the LAO projection. The lifetime risk of excess f atal malignancies normalized to 60 minutes of fluoroscopy was 0.07%for women an d 0 .1%for men. Conclusions-The relatively small amounts of the patient’s radiati on exposure in this study, despite the prolonged fluoroscopy durations, can be a ttributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of ma gnification, and optimal adjustments of the fluoroscopy exposure rates. The resu lting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.展开更多
Background: According to present knowledge, pulmonary vein isolation(PⅥ) bears a low interventional risk and has a high feasibility. For completion of PⅥ, left atrial access is achieved via single or double transsep...Background: According to present knowledge, pulmonary vein isolation(PⅥ) bears a low interventional risk and has a high feasibility. For completion of PⅥ, left atrial access is achieved via single or double transseptal puncture. We sought to determine the incidence and echocardiographic characteristics of persistent iatrogenic atrial septal defect(iASD) after PⅥ. Further objectives were to define clinical and periprocedural risk factors for the development of iASD. Methods: Every patient admitted for PⅥ at our hospital was screened for eligibility for study participation. Exclusion criteria were inability for undergoing transesophageal echocardiography, preexisting atrial septal defect, open-heart surgery or another transseptal procedure during the follow-up period. Transesophageal echocardiography was performed before PⅥ and after 9 months. Interatrial shunt was characterized by echocardiographic parameters; right-to-left shunting(RLS) was quantified by contrast echocardiography. Results: Forty-two patients were included, 27 patients underwent PⅥ with single transseptal puncture and additional advancement of a second electrophysiologic catheter(group A), 15 patients underwent PⅥ with double transseptal puncture(group B). In 8 patients of group A, iASD persisted after the follow-up period, including 6 patients with distinct RLS. We saw no iASD in group B(P=.011, CI-0.79 to-0.11). Preprocedural pulmonary artery pressure was significantly higher in patients with iASD and accompanying RLS, compared with patients with iASD and no evidence of RLS(23.75±0.50 vs 17.59±5.82, P=.048, CI 0.048-12.27). Conclusion: This is the first study that demonstrates a high incidence of long-term persistent iatrogenic atrial septal defect with RLS after PⅥ. All interatrial shunts occurred after single transseptal puncture with passage of 2 electrophysiologic catheters into the left atrium. Increased preprocedural pulmonary artery pressure seems to promote the occurrence of RLS across iASD.展开更多
文摘Background -The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation(AF) using the pulmonary vein(PV ) approach. Methods and Results -The study included 15 patients with AF and 5 p atients each with atrial flutter and atrioventricular nodal reentrant tachycardi a(AVNRT) who underwent fluoroscopically guided procedures on a biplane X-ray sy stem operated at a low-frame pulsed fluoroscopy(7.5 frames per second). Radiati on exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TL Ds). Peak skin doses(PSDs), effective radiation doses, and risk of fatal maligna ncies were all computed. Mean fluoroscopy durations for AF procedures were 67.8 ±21 minutes in the right anterior oblique(RAO) and 61.9±16.6 minutes in the le ft anterior oblique(LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0±0.5 Gyinthe RAO and 1.5±0.4 Gy in the LAO projection. The lifetime risk of excess f atal malignancies normalized to 60 minutes of fluoroscopy was 0.07%for women an d 0 .1%for men. Conclusions-The relatively small amounts of the patient’s radiati on exposure in this study, despite the prolonged fluoroscopy durations, can be a ttributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of ma gnification, and optimal adjustments of the fluoroscopy exposure rates. The resu lting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.
文摘Background: According to present knowledge, pulmonary vein isolation(PⅥ) bears a low interventional risk and has a high feasibility. For completion of PⅥ, left atrial access is achieved via single or double transseptal puncture. We sought to determine the incidence and echocardiographic characteristics of persistent iatrogenic atrial septal defect(iASD) after PⅥ. Further objectives were to define clinical and periprocedural risk factors for the development of iASD. Methods: Every patient admitted for PⅥ at our hospital was screened for eligibility for study participation. Exclusion criteria were inability for undergoing transesophageal echocardiography, preexisting atrial septal defect, open-heart surgery or another transseptal procedure during the follow-up period. Transesophageal echocardiography was performed before PⅥ and after 9 months. Interatrial shunt was characterized by echocardiographic parameters; right-to-left shunting(RLS) was quantified by contrast echocardiography. Results: Forty-two patients were included, 27 patients underwent PⅥ with single transseptal puncture and additional advancement of a second electrophysiologic catheter(group A), 15 patients underwent PⅥ with double transseptal puncture(group B). In 8 patients of group A, iASD persisted after the follow-up period, including 6 patients with distinct RLS. We saw no iASD in group B(P=.011, CI-0.79 to-0.11). Preprocedural pulmonary artery pressure was significantly higher in patients with iASD and accompanying RLS, compared with patients with iASD and no evidence of RLS(23.75±0.50 vs 17.59±5.82, P=.048, CI 0.048-12.27). Conclusion: This is the first study that demonstrates a high incidence of long-term persistent iatrogenic atrial septal defect with RLS after PⅥ. All interatrial shunts occurred after single transseptal puncture with passage of 2 electrophysiologic catheters into the left atrium. Increased preprocedural pulmonary artery pressure seems to promote the occurrence of RLS across iASD.
