[Radiation reduction in interventional electrophysiology : Results from operators with different levels of...

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.

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.

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.

Implementation of a radiation-reduced protocol leads to a significant reduction of radiation exposure even in less experienced operators during training.