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Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation
- Source :
- Journal of the American College of Cardiology. 50(3):234-242
- Publication Year :
- 2007
- Publisher :
- Elsevier BV, 2007.
-
Abstract
- ObjectivesThis study sought to evaluate the impact of obesity on patient radiation dose during atrial fibrillation (AF) ablation procedures under fluoroscopic guidance.BackgroundObesity is a risk factor for AF and its recurrence after ablation. It increases patient radiation dose during fluoroscopic imaging, but this effect has not been quantified for AF ablation procedures.MethodsEffective radiation dose and lifetime attributable cancer risk were calculated from dose-area product (DAP) measurements in 85 patients undergoing AF ablation guided by biplane low-frequency pulsed fluoroscopy (3 frames/s). Three dose calculation methods were used (Monte Carlo simulation, dose conversion coefficients, and depth-profile dose curves).ResultsMedian DAP for all patients was 119.6 Gy·cm2(range 13.9 to 446.3 Gy·cm2) for procedures with a median duration of 4 h and 83 ± 26 min of fluoroscopy. Body mass index was a more important determinant of DAP than total fluoroscopy time (r = 0.74 vs. 0.37, p < 0.001), with mean DAP values per hour of fluoroscopy of 58 ± 40 Gy·cm2, 110 ± 43 Gy·cm2, and 184 ± 79 Gy·cm2in normal, overweight, and obese patients, respectively. The corresponding effective radiation doses for AF ablation procedures were 15.2 ± 7.8 mSv, 26.7 ± 11.6 mSv, and 39.0 ± 15.2 mSv, respectively (Monte Carlo). Use of conversion coefficients resulted in higher effective dose estimates than other methods, particularly in obese patients. Mean attributable lifetime risk of all-cancer mortality was 0.060%, 0.100%, and 0.149%, depending on weight class.ConclusionsObese patients receive more than twice the effective radiation dose of normal-weight patients during AF ablation procedures. Obesity needs to be considered in the risk-benefit ratio of AF ablation and should prompt further measures to reduce radiation exposure.
- Subjects :
- Adult
Male
Radiobiology
medicine.medical_treatment
Radiation Dosage
Radiography, Interventional
Risk Assessment
Severity of Illness Index
Pulmonary vein
Ionizing radiation
Body Mass Index
Cohort Studies
Electrocardiography
Atrial Fibrillation
medicine
Dosimetry
Fluoroscopy
Humans
Obesity
Risk factor
Probability
Analysis of Variance
medicine.diagnostic_test
business.industry
Atrial fibrillation
Dose-Response Relationship, Radiation
Middle Aged
medicine.disease
Ablation
Survival Analysis
Treatment Outcome
Pulmonary Veins
Catheter Ablation
Female
Nuclear medicine
business
Cardiology and Cardiovascular Medicine
Follow-Up Studies
Subjects
Details
- ISSN :
- 07351097
- Volume :
- 50
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....bd1f53819b0211739079e6a63829d3f4
- Full Text :
- https://doi.org/10.1016/j.jacc.2007.03.040