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Development of radiation exposure in patients undergoing pulmonary vein isolation in Germany between 2007 and 2014: great potential to minimize radiation dosage

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Abstract

Aim

The aim of this study was to analyze the radiation usage in patients undergoing pulmonary vein isolation (PVI) in Germany and to evaluate the possibility to reduce radiation dose.

Methods and results

A total of 6617 patients with atrial fibrillation (AF) from the German ablation registry and the FREEZEplus registry (control group), who underwent first PVI between 2007 and 2014, were analyzed. In the second step, the effect of optimized conventional fluoroscopy and optimized 3D mapping use was evaluated in 526 consecutive patients with AF who underwent first PVI at the Klinikum Ludwigshafen (optimized group) between 2007 and 2014. In the control group, the median dose area product (DAP) for PVI was 34 Gy cm2, and the median DAP rate was 1.3 Gy cm2/min. The DAP decreased from 37 to 28 Gy cm2, whereas the DAP rate increased from 1.3 to 1.6 Gy cm2/min between 2007 and 2014. In the optimized group, optimized radiation application and use of 3D mapping resulted in a continuous decrease in the DAP from 67 to 2 Gy cm2 and DAP rate from 1.0 to 0.2 Gy cm2/min.

Conclusion

Currently, the median radiation exposure during PVI in Germany is 28 Gy cm2. Optimized fluoroscopy by simple means can safely reduce the radiation dose to about 2 Gy cm2 or even lower when using 3D mapping. Before introducing novel expensive technologies for radiation reduction optimizing of the conventional fluoroscopy is mandatory.

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Acknowledgments

The German ablation registry and the FREEZE trial were supported by the Institut für Herzinfarktforschung, Ludwigshafen, Germany. Medtronic funded the FREEZE trial.

Author information

Authors and Affiliations

  1. Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany

    Thomas Kleemann & Ralf Zahn

  2. Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany

    Johannes Brachmann

  3. Peter Osypka Herzzentrum München, Internistische Klinik Dr. Müller, München-Thalkirchen, Munich, Germany

    Thorsten Lewalter

  4. Department of Cardiology and Internal Medicine, Vivantes Klinikum Am Urban, Berlin, Germany

    Dietrich Andresen

  5. Department of Electrophysiology, University Heart Centre Hamburg, Hamburg, Germany

    Stephan Willems

  6. Praxisklinik Herz und Gefäße, Dresden, Germany

    Stefan G. Spitzer

  7. Klinik für Kardiologie und Internistische Intensivmedizin, Krankenhaus München Bogenhausen, Munich, Germany

    Ellen Hoffmann

  8. Division of Electrophysiology, Department of Cardiology and Angiology, University of Münster, Münster, Germany

    Lars Eckardt

  9. Stiftung Institute for Myocardial Infarction, Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

  10. Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany

    Karl-Heinz Kuck

  11. Medizinische Klinik I, Klinikum Ingolstadt, Ingolstadt, Germany

    Karlheinz Seidl

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  1. Thomas Kleemann
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  2. Johannes Brachmann
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  3. Thorsten Lewalter
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  5. Stephan Willems
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  6. Stefan G. Spitzer
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  7. Ellen Hoffmann
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  8. Lars Eckardt
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  9. Matthias Hochadel
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  11. Karl-Heinz Kuck
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  13. Ralf Zahn
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Corresponding author

Correspondence to Thomas Kleemann.

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Conflict of interest

Dr. Kleemann has nothing to disclose. Prof. Dr. Brachmann reports grants and personal fees from Medtronic during the conduct of the study; grants from Medtronic and from St. Jude outside the submitted work. Prof. Dr. Lewalter has nothing to disclose. Prof. Dr. Andresen has nothing to disclose. Prof. Dr. Willems reports personal fees from St. Jude Medical, Biosense Webster, Boston Scientific, Bristol Myers Squibb, Sanofi Aventis, Boehringer Ingelheim and Bayer. Prof. Dr. Spitzer reports personal fees from Medtronic, Recordati Pharma, Topera, AstraZeneca, St. Jude Medical, Biosense Webster, Bristol Myer Squibb, and Bayer Vital, outside the submitted work. Prof. Dr. Hoffmann reports grants from Biotronik SE & CoKG, Edwards Corp., Medtronic GmbH, Philips GmbH, Jude Medical GmbH, B. Braun AG, and Stentys Inc, personal fees from Bayer, Boehringer Ingelheim GmbH & CoKG, Boston Scientific, MSD Sharp & Dohme GMBH, and Astra Zeneca, outside the submitted work. Prof. Dr. Eckardt has nothing to disclose. Dr. Hochadel has nothing to disclose. Prof. Dr. Senges reports grants from Medtronic for the conduct of the Freezeplus Study. Prof. Dr. Kuck reports grants and personal fees from St. Jude Medical, grants and personal fees from Biosense Webster, grants and personal fees from Medtronic, outside the submitted work. Prof. Dr. Seidl reports grants from St. Jude Medical and Medtronic, during the conduct of the study; personal fees from St. Jude Medical, Medtronic, Bayer, Pfizer, and Boehringer Ingelheim, outside the submitted work. Prof. Dr. Zahn has nothing to disclose.

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Kleemann, T., Brachmann, J., Lewalter, T. et al. Development of radiation exposure in patients undergoing pulmonary vein isolation in Germany between 2007 and 2014: great potential to minimize radiation dosage. Clin Res Cardiol 105, 858–864 (2016). https://doi.org/10.1007/s00392-016-0994-9

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  • DOI: https://doi.org/10.1007/s00392-016-0994-9

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