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Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry
Author(s) -
Bru Paul,
Dompnier Antoine,
Amara Walid,
Haddad Georges,
Galuscan Gianina,
Sagnol Pascal,
Steinbach Mathieu,
Montagnier Christian,
Taieb Jérôme,
Beguec Julien,
Milhem Antoine
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13842
Subject(s) - medicine , interquartile range , quartile , cardiac resynchronization therapy , fluoroscopy , multicenter study , radiation exposure , dose area product , dosimeter , nuclear medicine , implantable cardioverter defibrillator , confidence interval , cardiology , radiology , dosimetry , heart failure , randomized controlled trial , ejection fraction
Abstract Background Little data are available about radiation exposure during cardiac electrical device implantation, and no dose reference levels have been published. This multicenter, prospective, observational study assesses patient and staff radiation exposure during cardiac device implantations, and aims at defining dose reference levels. Methods Patient demographic, procedural, and radiation data were obtained for 657 procedures from nine institutions. Physician and staff exposure were measured using real‐time dosimeters worn beneath and above lead apron. Statistical analysis included fluoroscopy time (FT), dose‐area product (DAP), and DAP adjusted for FT and body mass index. Results Pacemakers and cardioverter defibrillators were implanted in 481 and 176 patients, respectively. Of these, 152 were treated with cardiac resynchronization therapy (CRT). Median FTs were 837s (interquartile range [IQR]: 480‐1323), 117s (IQR: 69‐209), and 101s (IQR: 58‐162), and median DAPs were 1410 (IQR: 807‐2601), 150 (IQR: 72‐338), and 129 (IQR: 72‐332) cGy.cm² for biventricular, dual chamber, and ventricular device implantation, respectively. Dose reference levels correspond to the third quartile values. During CRT, higher exposure was observed with four X‐ray systems than with the two newer and customizable ones (adjusted DAP of 0.90 [IQR: 0.26‐1.01] and 0.29 [IQR: 0.23‐0.39], respectively; P < .001). Conclusion Based on real‐life measurements, this multicenter registry provides dose reference levels and may help centers assess radiation exposure. Although biventricular device implantation was responsible for the highest radiation exposure, FT was meaningfully shortened compared to previously reported values. For a same FT, the use of new generators and custom settings has significantly reduced DAP.