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Objective:To identify the method to reduce X-ray exposure during ablation of atrial fibrillation (AF) by comparing the cryoballoon (CRYO) ablation and remote magnetic navigation (RMN) ablation.Methods:A retrospective analysis was conducted on 144 patients undergoing CRYO ablation (CRYO group) and 121 patients undergoing RMN ablation (RMN group) in our hospital. Entrance surface doses at reference points online, exposure time during procedure and outcomes were analyzed for different types of patients.Results:Compared with the RMN group, the procedure time for the CRYO group significantly decreased [(165.0±23.6), (97.8±18.4) min, t=26.05, P<0.001]. However, the entrance surface dose value [(232.3±130.7), (669.0±387.5) mGy, Z=-12.29, P<0.001] and X-ray exposure time [(8.1±3.1), (23.4±6.2) min, t=-24.57, P<0.001] increased significantly for the CRYO group. No significant difference was found between the two groups in the proportion of maintaining sinus rhythm during follow-up of patients (71.9%, 75.7%, P=0.618). Multiple regression analysis showed that obese patients, patients with non-paroxysmal AF and patients with variant pulmonary veins were associated with an increase in entrance surface dose values in the CRYO group ( t=5.47, 2.23, 3.39, P<0.05). The X-ray exposure time for the three types patients above in the CRYO group also increased ( t=2.87, 3.86, 3.25, P<0.05) in the CRYO group. However, only obese patients in the RMN group had an increase in entrance surface dose value ( Z=-4.15, P<0.001) and no increase in exposure time. For the three types of patients above, there was no significant difference in proportion of maintaining sinus rhythm between the CRYO group and the RMN group during follow-up ( P>0.05). Conclusions:Compared with RMN ablation, the radiation exposure of CRYO AF ablation significantly increased, especially in obese patients, patients with non-paroxysmal AF and patients with pulmonary veins variation. The use of RMN for these types of patients may reduce the radiation exposure without affecting the procedure outcomes.
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Objective To analyze the eye lens equivalent dose levels of doctors during interventional cardiology procedures and identify related influential factors. Methods Twenty interventional specialists were selected from a cardiovascular specialty hospital. The cumulative equivalent doses to their eye lens during operations were monitored, and equipment-related parameters (fluoroscopy time, dose area product value [DAP], and entrance skin dose[ESD]), operation types, and operators’ positions were recorded. Results The annual equivalent doses to the eye lens of seven doctors exceeded 20 mSv. There was a linear correlation between the weekly number of operations and the equivalent dose to the eye lens (R2 = 0.457, P = 0.001). The mean eye lens equivalent dose per operation was 17.1 μSv, showing linear correlations with fluoroscopy time, DAP values, and ESD values (R2 = 0.427, 0.206, and 0.237, respectively, P < 0.05). The fluoroscopy time, DAP value, ESD value, and eye lens equivalent dose during percutaneous coronary intervention (PCI) were significantly higher than those during coronary angiography (t = −3.226, −3.108, −3.061, and −2.667, respectively, P < 0.03). Conclusion The annual equivalent doses to the eye lens are relatively high in interventional radiologists, some of whom may have values higher than the latest dose limit (20 mSv) suggested by the International Commission on Radiological Protection. Attention should be paid to operators performing PCI, and the workload optimization is necessary in practical operations to avoid unnecessary fluoroscopy time and reduce the eye lens doses of the operators.
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Objective To evaluate the efficacy of the DAP database in reducing radiation hazards during cardiovascular intervention.Methods The study conducted a retrospective analysis of all consecutive cardiovascular cases in the database from April 1st,2016 to June 30th,2016.Based on the imaging systems,an inage intensifier (Ⅱ) and a flat panel detector (FPD),the cases of patients undergoing coronary angiography (CAG) and percutaneous coronary interventions (PCI) were collected to observe Body Mass Index (BMI),fluoroscopy time (FT) and dose area product (DAP).Results The FT and DAP values in CAG were (3.26-±2.59) min and (1 938±1 296) μGy·m2 for the Ⅱ system and (3.00 ± 2.89) min and (3 718 ± 2 859) μGy· m2 for the FPD system,respectively,whereas,the FT and DAP values in PCI were (17.81 ± 12.71) min and (8 899 ±7 032) μGy·m2 for the Ⅱ system and (21.99 ± 15.91) min and (19 526 ± 14 134) μGy · m2 for the FPD system,respectively.The differences in DAP values (x ± s) for CAG and PCI between the angiography systems were significant(t =-10.664,11.239,P ＜ 0.05).The DAP and total DAP values during PCI for fluoroscopy from the FPD systen were 3 596 755.60 and 4 881 484.50 μGy · m2,respectively.Conclusions The DAP values in CAG and PCI using FPD system are much higher than the relevant data.The use of an FPD system resulted in higher DAP values compared to the Ⅱ system in cardiovascular interventional procedures.Reduction in fluoroscopy time may decrease radiation hazards during PCI.The DAP database allows for a fast,convenient and enough objective data to discovery timely difference and variation in dose in cardiovascular interventional procedures.
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Objective To compare the application effect between problem-based learning (PBL) and traditional teaching in cardiovascular intervention . Methods 39 training physicians were divided randomly into the PBL group (n=20) and control group (n=19). The control group was trained with the tradi-tional teaching method while PBL group used PBL seven step method, namely they were trained through the process of clarifying unfamiliar terms—defining the problem—brainstorming—restructuring problem—defining learning goals—collecting information, personal learning, information sharing, and group discus-sion. After the end of the training, the two groups were tested by using the unified test questions and skills test, and the questionnaire survey of teaching satisfaction. SPSS 18.0 was used to do line t test or chi square test to the data of both groups. Results PBL group training physicians' cardiovascular intervention oper-ation [(30.07±1.67) vs. (28.54±1.98), P=0.036], their comprehensive analysis of clinical cases, [(34.47± 1.77) vs. (32.08 ±1.80), P=0.002], and the total score [(86.47 ±2.75) vs. (82.23 ±3.63), P=0.002], were better than the control group, and the difference was statistically significant. The survey results showed that the PBL group's evaluation on how the teaching methods stimulate the training physicians' interest in learning, enhance their ability of independent thinking and cultivate their teamwork ability, improve their language expression and clinical thinking and other aspects was higher than the control group (P Conclusion Compared with the traditional teaching, the application effect of PBL in the training of car-diovascular intervention can better exert training physicians' subjective initiative and improve the teaching effect.
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Objective To compare the X-ray radiation dose from atrial fibrillation (AF) ablation guided by magnetic navigation system (MNS) and manual procedure (CON).Methods 94 AF patients were randomly divided into MNS group (34 cases) and CON group(60 cases).The dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time of patients,the X-ray exposure time and dose of operators were recorded and analyzed.Results The results from the patients in MNS group and CON group were CD values (0.54 ±0.45) and (1.61 ±0.89) Gy (t =2.44,P ＜0.05),DAP values (46.86 ±27.09) and (139.71 ±76.69) Gy·cm2(t =3.89,P ＜0.05) and fluoroscopy time (15.60 ±7.52) and (39.50 ± 8.82) min (t =1.96,P ＜ 0.05),respectively.The X-ray exposure dose in both groups were (22.68 ± 6.87) and (62.74 ± 20.92) μSv (t =2.02,P ＜ 0.05) for operation doctor (19.38 ± 5.64) and (49.42 ± 10.67) μ Sv (t =3.58,P ＜ 0.05) for operation assistant and (18.98 ± 4.99) and (47.77 ± 13.65) μ Sv (t =3.17,P ＜ 0.05) for nurse,respectively.The X-ray exposure time experienced in both groups were (11.48 ±7.59) and (30.50 ±14.82) min (t =2.75,P ＜0.05) for operation doctor,(8.96 ±5.88) and (24.49 ±9.09) min (t =4.20,P ＜0.05) for operation assistant and (8.33 ±6.35) and (22.99 ± 13.36) min(t =2.76,P ＜ 0.05) for nurse,respectively.Conclusions Compared with manual procedure,the MNS applied in AF ablation has the potential to decrease X-ray exposure dose.
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Objective To explore the X-ray radiation dose to patients from different cardiovascular interventional procedures and analyze the dose-affecting factors.Methods In accordance with the A,B,C operators,442 patients undergoing cardiovascular interventional procedures were collected,including single coronary angiography (CAG),percutaneous coronary intervention ( PCI ),radiofrequency catheter ablation (RFCA),congenital heart disease intervention (CHD) and permanent cardiac pacemaker implantation (PCPI),to observe dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time.Results CD values of patients in groups of CAG,PCI,RFCA,CHD,PCPI were (0.34 ±0.23),(1.33 ±0.76),(0.71 ±0.43),(0.27 ±0.22) and (0.92±0.42) Gy and DAP values were (34.18 ±23.33),(135.92 ±81.14),(79.79 ±50.66),(27.93 ±23.66),and (94.60 ±48.11 ) Gy·cm2,respectively.Fluoroscopy time were (4.82 ±3.73),( 16.64 ±9.01 ),( 17.04 ± 15.29),(9.60 ±5.97)and (7.31 ±6.45) min.DAP values and fluoroscopy time were highly correlated (r =0.84,P ＜ 0.05 ).Conclusions There is significant difference in radiation dose for cardiovascular interventional procedures.Radiation dose and fluoroscopy time are directly related to surgeons' proficiency in operations.Improvement of operation proficiency should be carried out to reduce the patients' radiation dose.
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Objective To explore the effect of minimally invasive clinical pathway in patients after car-diac interventional therapy. Methods One hundred and twenty patients who received cardiac interventional therapy from June 2005 to October 2006 were divided into the control group and the observation group.The control group received routine nursing while the observation group adopted minimally invasive clinical pathway of nursing.The nursing effect in the two groups was compared. Results The mean hospitalized duration, sat-isfaction degree and health knowledge level in the observation group were superior to those of the control group (P ＜ 0.05). Conclusions The adoption of minimally invasive clinical pathway in patients after cardiac inter-ventional therapy could increase working efficiency nd ensure the nusing quality.
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Complications of vascular access are main component of vascular complication in percutaneous cardiovascular intervention.The common complications of femoral access may include hemorrhage and hematoma at access site,vasovagal reflex,pseudoaneurysm,arteriovenous fistula,retroperitoneal hematoma and deep venous thrombosis.The common complications of radial access may include radial artery spasm,radial artery occlusion,vascular injuries or hematoma at forearm and other sites,and osteofascial compartment syndrome.The common complications of ulnar and brachial accesses may include hemorrhage and hematoma at access site,upper limb and hand ischemia,and nerve injuries.Effective prevention and treatment of vascular access complications are key steps to minimize the incidence and hazards of vascular complications in percutaneous cardiovascular intervention.