Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: A prospective study

Dhanunjaya Lakkireddy, George Nadzam, Atul Verma, Subramanya Prasad, Kay Ryschon, Luigi Di Biase, Mohammed Khan, David Burkhardt, Robert Schweikert, Andrea Natale

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background: Pulmonary vein antral isolation (PVAI) is an effective treatment for atrial fibrillation and involves prolonged procedure and fluoroscopy times. This study assesses the impact of a comprehensive radiation safety program on patient and operator radiation exposure during PVAI. Methods and Results: We evaluated a comprehensive radiation safety program including: (1) verbal reinforcement of previous fluoroscopy times (2) effective collimation (3) minimizing source-intensifier distance and (4) effective lead shield use. Exposure doses in 41 consecutive patients without (group-I, n=21) and with (group-II, n=20) the use of radiation safety program were assessed. PVAI was done using intracardiac echo (ICE) guided roving circular mapping catheter. A 3-dimensional mapping system was used in 27% cases for additional guidance. Operator and patient exposure was measured during the PVAI. The age, gender, body mass index and AF duration were similar in both of the groups. The total procedure (166±56 vs 178±38 min, p=0.54) and fluoroscopy times (74±24 vs 70±20 min, p=0.72) were comparable. Group-II had significantly lower dose area product (234±120 vs 548±363 Gy cm2, p=0.03) compared to group-I. The mean operator exposure was reduced by half and mean patient peak skin dose by three to ten times with comprehensive radiation safety program. None of the patients were noted to have radiation related skin injuries. Additional lifetime cancer risk was significantly lower in group-II patients (0.08 vs 0.2%, p<0.001) than group-I. Conclusions: Implementation of a comprehensive radiation safety program described above significantly decreases the radiation exposure to the patient as well as the operator.

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Issue number2
StatePublished - Mar 2009
Externally publishedYes


  • Ablation
  • Atrial fibrillation
  • Pulmonary vein antral isolation
  • Radiation
  • Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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