[Radiation reduction in interventional electrophysiology : Results from operators with different levels of experience]. / Strahlenreduktion in der interventionellen Elektrophysiologie : Verlaufsdaten bei Untersuchern mit unterschiedlicher Erfahrung.

BACKGROUND: Radiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether a reduction of radiation exposure with the use of "near-zero fluoroscopy" protocols is possible when applied by less experienced operators. METHODS: Consecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) a near "near-zero fluoroscopy" protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed a growing number of procedures with the "near-zero fluoroscopy" protocol. RESULTS: In all, 290 procedures were analyzed. After implementation of a radiation-reduced protocol, a significant reduction of radiation exposure was observed (standard 850 ± 831.7 vs. initial phase 197.2 ± 481.8 µGy/m2, p < 0.001, and vs. routine use 283 ± 493.8 µGy/m2, p < 0.001). No significant difference was observed between the initial phase and routine phase (p = 1). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; p < 0.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; p = 0.002). Complication rates were not significantly different. CONCLUSIONS: Implementation of a radiation-reduced protocol leads to a significant reduction of radiation exposure even in less experienced operators during training.

Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience.

PURPOSE: Catheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels. METHODS: From January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator. RESULTS: Procedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637 ± 611 µGy/m2; beginner 44.1 ± 79.5 µGy/m2, p = 0.002; 1st year fellow 24.3 ± 46.4.5 µGy/m2, p = 0.001; 2nd year fellow 130.3 ± 233.3 µGy/m2, p = 0.003; expert 9.3 ± 37.4 µGy/m2, P < 0.001). Procedure duration, acute success, and complications were not significantly different between the groups. CONCLUSION: Our results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.