Completely nonfluoroscopic catheter ablation of left atrial arrhythmias and ventricular tachycardia

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Abstract

Fluoroscopy use during catheter ablation procedures increases the cumulative lifetime radiation exposure of patients and operators, potentially leading to a higher risk of cancer and radiation-related injuries. Nonfluoroscopic ablation (NFA) has been described for supraventricular tachycardia, typical atrial flutter, paroxysmal atrial fibrillation (AF), and outflow-tract ventricular tachycardia (VT). Complete transition to NFA of more complex arrhythmias, including persistent AF, left atrial (LA) flutter, and structural VT, has not been previously described. We describe the transition to completely NFA of complex arrhythmias, including LA flutter and structural VT. The techniques, challenges, limitations, and results are described.

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Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography.

Andrew J Einstein, Milena J Henzlova, Sanjay Rajagopalan (2007)

Computed tomography coronary angiography (CTCA) has become a common diagnostic test, yet there are little data on its associated cancer risk. The recent Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 report provides a framework for estimating lifetime attributable risk (LAR) of cancer incidence associated with radiation exposure from a CTCA study, using the most current data available on health effects of radiation. To determine the LAR of cancer incidence associated with radiation exposure from a 64-slice CTCA study and to evaluate the influence of age, sex, and scan protocol on cancer risk. Organ doses from 64-slice CTCA to standardized phantom (computational model) male and female patients were estimated using Monte Carlo simulation methods, using standard spiral CT protocols. Age- and sex-specific LARs of individual cancers were estimated using the approach of BEIR VII and summed to obtain whole-body LARs. Whole-body and organ LARs of cancer incidence. Organ doses ranged from 42 to 91 mSv for the lungs and 50 to 80 mSv for the female breast. Lifetime cancer risk estimates for standard cardiac scans varied from 1 in 143 for a 20-year-old woman to 1 in 3261 for an 80-year-old man. Use of simulated electrocardiographically controlled tube current modulation (ECTCM) decreased these risk estimates to 1 in 219 and 1 in 5017, respectively. Estimated cancer risks using ECTCM for a 60-year-old woman and a 60-year-old man were 1 in 715 and 1 in 1911, respectively. A combined scan of the heart and aorta had higher LARs, up to 1 in 114 for a 20-year-old woman. The highest organ LARs were for lung cancer and, in younger women, breast cancer. These estimates derived from our simulation models suggest that use of 64-slice CTCA is associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, younger patients, and for combined cardiac and aortic scans.

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Safety of transesophageal echocardiography.

Michael N D'Ambra, Nicholas D. Oakes, Bernard E. Bulwer … (2010)

Since its introduction into the operating room in the early 1980s, transesophageal echocardiography (TEE) has gained widespread use during cardiac, major vascular, and transplantation surgery, as well as in emergency and intensive care medicine. Moreover, TEE has become an invaluable diagnostic tool for the management of patients with cardiovascular disease in a nonoperative setting. In comparison with other diagnostic modalities, TEE is relatively safe and noninvasive. However, the insertion and manipulation of the ultrasound probe can cause oropharyngeal, esophageal, or gastric trauma. Here, the authors review the safety profile of TEE by identifying complications and propose a set of relative and absolute contraindications to probe placement. In addition, alternative echocardiographic modalities (e.g., epicardial echocardiography) that may be considered when TEE probe placement is contraindicated or not feasible are discussed. Copyright © 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

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Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations.

Shital J Patel, Deborah L Reede, Douglas S Katz … (2007)

Use of diagnostic imaging studies for evaluation of pregnant patients with medical conditions not related to pregnancy poses a persistent and recurring dilemma. Although a theoretical risk of carcinogenesis exists, there are no known risks for development of congenital malformations or mental retardation in a fetus exposed to ionizing radiation at the levels typically used for diagnostic imaging. An understanding of the effects of ionizing radiation on the fetus at different gestational stages and the estimated exposure dose received by the fetus from various imaging modalities facilitates appropriate choices for diagnostic imaging of pregnant patients with nonobstetric conditions. Other aspects of imaging besides radiation (ie, contrast agents) also carry potential for fetal injury and must be taken into consideration. Imaging algorithms based on a review of the current literature have been developed for specific nonobstetric conditions: pulmonary embolism, acute appendicitis, urolithiasis, biliary disease, and trauma. Imaging modalities that do not use ionizing radiation (ie, ultrasonography and magnetic resonance imaging) are preferred for pregnant patients. If ionizing radiation is used, one must adhere to the principle of using a dose that is as low as reasonably achievable after a discussion of risks versus benefits with the patient. RSNA, 2007