[Radiographic implications of procedures involving cardiac implantable electronic devices (CIEDs) - Selected aspects]

Some cardiac implantable electronic device (CIED) implantation procedures require the use of X-rays, which is reflected by such parameters as total fluoroscopy time (TFT) and dose-area product (DAP - defined as the absorbed dose multiplied by the area irradiated).

This retrospective study evaluated 522 CIED implantation (424 de novo and 98 device upgrade and new lead placement) procedures in 176 women and 346 men (mean age 75±11 years) over the period 2012-2015. The recorded procedure-related parameters TFT and DAP were evaluated in the subgroups specified below. The group of 424 de novo procedures included 203 pacemaker (PM) and 171 implantable cardioverter-defibrillator (ICD) implantation procedures, separately stratified by single-chamber and dual-chamber systems. Another subgroup of de novo procedures involved 50 cardiac resynchronization therapy (CRT) devices. The evaluated parameters in the group of 98 upgrade procedures were compared between 2 subgroups: CRT only and combined PM and ICD implantation procedures.

We observed differences in TFT and DAP values between procedure types, with PM-related procedures showing the lowest, ICD - intermediate (with values for single-chamber considerably lower than those for dual-chamber systems) and CRT implantation procedures - highest X-ray exposure. Upgrades to CRT were associated with 4 times higher TFT and DAP values in comparison to those during other upgrade procedures. Cardiac resynchronization therapy de novo implantation procedures and upgrades to CRT showed similar mean values of these evaluated parameters.

Total fluoroscopy time and DAP values correlated progressively with CIED implantation procedure complexity, with CRT-related procedures showing the highest values of both parameters. Med Pr 2017;68(3):363-374.