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J Am Heart Assoc. 2018 May 22;7(11). pii: e008233. doi: 10.1161/JAHA.117.008233.

X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory.

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Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY.
Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX.
Department of Biomedical Engineering, University of Texas at Austin, TX.
Department of Cardiology, University of Foggia, Italy.
Dell Medical School, University of Texas at Austin, TX.
California Pacific Medical Center, San Francisco, CA.
Department of Clinical Science and Community Health, University of Milan, Italy.



Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x-ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects.


We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large-volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7-year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P<0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P<0.0001) and a significant reduction of fluoroscopy use over time (P<0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P<0.001).


Electrophysiological procedures involve a nonnegligible x-ray use, leading to an increased risk of malignancy. Awareness of radiation-related risk, together with technological advances, can successfully optimize fluoroscopy use.


atrial fibrillation; catheter ablation; x‐ray

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