Introduction: There is growing concern regarding radiation hazards for both patients and staff. The aim of this study was to investigate the efficacy and safety of a new low-dose fluoroscopy technique for cardiac electronic device implantation, and compare it with a conventional approach.
Low-dose fluoroscopy technique: Radiation exposure during fluoroscopy is directly proportional to the time the unit is activated. Traditionally, the fluoroscopist keeps his foot on the pedal switch for at least a few seconds, in order to visualize the “live” movements of either the leads during their positioning or the needle during a fluoroscopy-guided puncture of the subclavian vein. Our technique consists of setting a low frame rate per second (range 0.5–3.75 fps) and pressing the fluoroscopy foot pedal switch for a fraction of second only. This obtains screenshots of the position of the leads/needle.
Study design: This validation study consisted of 66 consecutive patients undergoing permanent pacemaker (PPM) or cardiac defibrillator (ICD) implant in our centre from July to May 2019 using the above-described technique. Cumulative radiation dose was measured using dose-area product (DAP). Rates of success and complications were assessed at 30 days. The procedural details and outcomes were compared with a matched-cohort of patients with PPM or ICD implanted in our centre by senior operators, using a traditional fluoroscopic approach, from March 2018.
Results: A PPM or ICD was successfully implanted in all patients. Fluoroscopy time and DAP were significantly lower in the low-dose fluoroscopy group, mean 1.9 ± 1.7 seconds versus 216 ± 212.7 seconds (p<0.001) and 3.4 ± 2.4 µGym2 versus 31.9 ± 30.6 µGym2 (p<0.001), respectively. Mean procedure time was 45.3 ± 14.7 minutes in the low fluoroscopy group and 55.7 ± 28.3 minutes in the control group (p=0.048). Median frame per second setting was 0.5 in the low-dose cohort. At 30 days, there was one lead displacement in each group.
Conclusion: This new near-zero dose fluoroscopy technique is safe and allows a significant reduction of the radiation exposure during PPM and ICD implantation compared to a traditional approach.