Background Fluoroscopy has been an essential part of every electrophysiological procedure
since its inception. However, till now no clear standards regarding acceptable x-ray
exposure nor recommendation how to achieve them have been proposed.Hypothesis Current
norms and quality markers required for optimal clinical routine can be identified.Methods
Centers participating in this Europe-wide multicenter, prospective registry were requested
to provide characteristics of the center, operators, technical equipment as well as
procedural settings of consecutive cases.Results Twenty-five centers (72% university
clinics, with a mean volume of 526 +/- 348 procedures yearly) from 14 European countries
provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation
(AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations
(VT)] conducted by 95 operators (89% male, 41 +/- 7 years old).Mean dose area product
(DAP) and time was 304 +/- 608 cGy*cm(2), 3.6 +/- 4.8 minutes, 1937 +/- 608 cGy*cm(2),
15.3 +/- 15.5 minutes, 805 +/- 1442 cGy*cm(2), 10.6 +/- 10.7 minutes, and 1277 +/-
1931 cGy*cm(2), 10.4 +/- 12.3 minutes for DP, AF, SVT, and VT ablations, respectively.
Seven percent of all procedures were conducted without any use of fluoroscopy.Procedures
in the lower quartile of DAP were performed more frequently by female operators (OR
1.707, 95%CI 1.257-2.318, P = .001), in higher-volume center (OR 1.001 per one additional
procedure, 95%CI 1.000-1.001, P = .002), with the use of 3D-mapping system (OR 2.622,
95%CI 2.053-3.347, P < .001) and monoplane x-ray system (OR 2.945, 95%CI 2.149-4.037,
P < .001).Conclusion Exposure to ionizing radiation varies widely in daily practice
for all procedure. Significant opportunities for harmonization of exposure toward
the lower range has been identified.
