YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==CARDIAC ABLATION - RISKS== 2 AUTHOR KOVOOR P AUTHOR UTHER JB AUTHOR RICCIARDELLO M AUTHOR ROSS DL AUTHOR COLLINS L TITLE Radiation exposure to patient and operator during radiofrequency ablation for supraventricular tachycardia. SOURCE AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE; 25 (5). 1995. 490-495. ABSTRACT BIOSIS COPYRIGHT: BIOL ABS. Background: Radiofrequency (RF) ablation has become the primary method of treatment for supraventricular tachycardia and often requires prolonged fluoroscopy times. Aim: To quantitate radiation exposure to patient and operator during RF ablation for supraventricular tachycardia. Methods: Thermoluminescent dosemeters were used to monitor radiation at seven sites. Positions were: patient's thyroid, left scapula, T9 vertebra, right scapula and L4-L5 vertebra and the operator's thyroid and left hand. Monitoring was performed during 22 procedures. Of the patients studied 10 (45%) had atrioventricular junctional re-entry tachycardia (AVJRT) and 12 (55%) had accessory pathway tachycardia. Results: The median fluoroscopy times (minutes) and inter-quartile ranges were 46 (39-65) for AVJRT, 55 (52-60) for left free wall accessory pathway (LFW), 107 (89-140) for septal and 166 (128-176) for RFW pathways. The mean radiation doses (mGy) to the chest wall were 50 for AVJRT, 47 for LFW, 87 for septal and 151 for RFW pathways. The mean radiation to the chest wall of the patient per case was found to be 3.9 times that reported for diagnostic cardiac catheterization and 1.5 times that reported for angioplasty. Conclusions: Radiofrequency ablation is associated with significant irradiation of the patient and operator. All precautions should be taken to decrease this exposure. If eye irradiation is assumed to be equal to that to the thyroid, more than 45 procedures per month by a single operator (using ceiling-suspended lead glass shielding) may result in exceeding the recommended dose limit to the eye. 1 AUTHOR Park TH AUTHOR Eichling JO AUTHOR Schechtman KB AUTHOR Bromberg BI AUTHOR Smith JM AUTHOR Lindsay BD TITLE Risk of radiation induced skin injuries from arrhythmia ablation procedures. SOURCE Pacing Clin Electrophysiol; VOL 19, ISS 9, 1996, P1363-9 ABSTRACT Catheter guided ablation of cardiac arrhythmias is an effective and safe procedure for the treatment of most supraventricular and selected ventricular tachycardias. Because catheter manipulation is fluoroscopically guided, there is risk of radiation induced injury, especially during prolonged procedures. The Food and Drug Administration has recently issued a bulletin warning of the risks of acute skin injury occurring during fluoroscopically guided procedures that result in an exposure level exceeding 2 Gray units (Gy). This study was performed as an investigation into the risk of radiation induced skin injury during arrhythmia ablation procedures. The amount of radiation exposure for 500 patients who underwent ablation was calculated based upon fluoroscopy times and the entrance dose of radiation (0.02 Gy/min). The mean radiation exposure was 0.93 +/- 0.62 Gy. Although 5.6% of patients (n = 28) received enough radiation exposure to reach the threshold dose (2 Gy) for early transient erythema, no clinical manifestations of acute radiation induced skin injury were observed. No patients achieved the threshold dose for irreversible skin injury. Patients undergoing AV node ablation or modification received significantly less radiation (0.39 +/- 0.40 Gy and 0.79 +/- 0.44 Gy, respectively) than patients undergoing other ablation procedures (0.94-1.45 Gy, P < 0.05). There was no association between the magnitude of radiation exposure and the presence of underlying heart disease. Patients undergoing ablation of accessory pathways were exposed to more radiation if there was a right-sided pathway (1.69 +/- 0.93 Gy) compared to other sites (0.87-1.24 Gy, P < 0.05). This study demonstrates that the risk of significant radiation induced skin injury during arrhythmia ablation procedures is low provided that precautions are taken to minimize radiation exposure. 2 AUTHOR Deshpande S AUTHOR Jazayeri M AUTHOR Dhala A AUTHOR Blanck Z AUTHOR Sra J AUTHOR Bremner S AUTHOR Akhtar M TITLE Catheter ablation in supraventricular tachycardia. SOURCE Annu Rev Med; VOL 46, 1995, P413-30 (REF: 63) ABSTRACT The evolution of catheter ablation for the treatment of supraventricular tachycardias represents a major advance in the management of cardiac arrhythmias. Excellent results in the majority of patients undergoing the procedure, together with a low rate of early complications and a brief hospitalization, make catheter ablation a highly cost-effective permanent cure. At present, however, its place in relation to alternate therapies in the management of supraventricular tachycardias has not been clearly established owing to unresolved risk-benefit issues. Continuing technical advances will likely enable catheter ablation to be successfully applied to a broader range of cardiac arrhythmias.