Systematic low frame rate fluoroscopy: An efficient approach to achieve an ALARA protocol during arrhythmia catheter ablation in pediatric patients

Arrhythmia catheter ablation (CA) in children with the use of fluoroscopy carries risks inherent to ionizing radiation exposure. The objective of this study was to demonstrate the pertinence of using low frame rates during CA in children to maximally decrease radiation dose and hence mitigate the radiation hazards. In total, 168 successive patients < 18 years of age who underwent arrhythmia CA performed under a 3.5 frames/second rate were retrospectively included. Demographics, procedural and dosimetry data were analyzed. The effective dose was evaluated in a subgroup of 14 patients. Mean age and weight were respectively 14.4 ± 2.6 years and 55 ± 15 kg. Of this population, 72% had WPW (Wolff-Parkinson-White syndrome), 10% atrioventricular nodal reentrant tachycardia and 10% ventricular tachycardia (atrial tachycardia, flutter, and atrial fibrillation for the other cases). The mean procedure duration was 132 ± 78 minutes and the mean fluoroscopy duration was 24 ± 20 minutes. Dose area product (DAP) and Air Kerma (AK) were 6.9 ± 24.7 Gy.cm 2 (range 0.06–315) and 31 ± 66 mGy (range 2–489) respectively. DAP was 4.4 ± 9 Gy.cm 2 and AK 20.6 ± 15.9 mGy in WPW ablation. A significant reduction of DAP was noted over the years from 8.3 ± 13.0 Gy.cm 2 in 2011 to 1.6 ± 1.4 in 2019, a figure which is much lower than previous findings. The success rate was 98.5%. The estimated effective dose (ED) was 0.38 ± 0.47 mSv (0.3 to 1.64), falling into the range of yearly normal natural irradiation or caused by leisure and professional activity. Low frame rate fluoroscopy is a highly effective approach in decreasing radiation exposure during arrhythmia CA in children without altering the success rate of the procedure. In contrast to the 3 D mapping system, this approach is cost–effective and thus can be widely generalized.