PMID- 30413993
OWN - NLM
STAT- MEDLINE
DCOM- 20200109
LR  - 20200225
IS  - 1572-8595 (Electronic)
IS  - 1383-875X (Linking)
VI  - 55
IP  - 1
DP  - 2019 Jun
TI  - Assessment of a novel radiation reduction protocol for pediatric and adult 
      congenital device implantation.
PG  - 93-98
LID - 10.1007/s10840-018-0479-z [doi]
AB  - PURPOSE: Device implantation requires fluoroscopic guidance, which carries 
      inherent risks of ionizing radiation. We evaluated the impact of a low-dose 
      fluoroscopic protocol on radiation exposure during device implantation. METHODS: 
      All patients who underwent pacemaker or ICD implantation with new transvenous 
      leads from July 2011 to January 2018 were included. A novel ALARA protocol 
      consisting of ultra-low frame rates (2-3 frames/s), low dose/frame 
      (6-18 mGy/frame), and use of the "air-gap" technique in patients < 20 kg was 
      employed. Demographics, procedural data, and radiation exposure levels were 
      collected and analyzed. RESULTS: Thirty patients underwent device implantation 
      without additional catheterization, electrophysiology study, or ablation 
      procedure (median age 15 years; range 5-50) with a total of 43 leads placed. 
      Forty-seven percent of patients had a primary rhythm disturbance, 33% had 
      cardiomyopathy, and 20% had congenital heart disease. Fifty percent were 
      pacemakers (53% dual-chamber, 27% ventricle, 20% atrial) and 50% of devices 
      implanted were ICDs (87% single-chamber). All implants were acutely successful 
      with acceptable atrial and ventricular sensing and capture thresholds. The median 
      fluoroscopy time was 11.5 min (inter-quartile range (IQR) 8.0-18.2), median air 
      kerma dose 4.0 mGy (IQR 2.5-19.5), and median dose-area product 27.8 muGy/m(2) 
      (IQR 17.1-106.5). Median implant procedure time was 133 min. One patient required 
      revision secondary to device migration without lead derangement 2 days 
      post-procedure. CONCLUSIONS: Use of a novel fluoroscopic protocol may help 
      decrease radiation exposure to patients and staff without affecting efficacy or 
      risk. These data may represent benchmarks against which future device 
      implantation procedures can be compared.
FAU - Clark, Bradley C
AU  - Clark BC
AUID- ORCID: 0000-0002-8186-8471
AD  - Children's Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 1 Pediatrics, 
      Bronx, NY, 10467, USA. bradleyclarkep@gmail.com.
AD  - Albert Einstein College of Medicine, Bronx, NY, USA. bradleyclarkep@gmail.com.
FAU - Janson, Christopher M
AU  - Janson CM
AD  - Children's Hospital of Philadelphia, Philadelphia, PA, USA.
FAU - Ceresnak, Scott R
AU  - Ceresnak SR
AD  - Lucile Packard Children's Hospital, Palo Alto, CA, USA.
FAU - Osei, Frank A
AU  - Osei FA
AD  - University of Mississippi Medical Center, Tupelo, MS, USA.
FAU - Bonney, William J
AU  - Bonney WJ
AD  - Children's Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 1 Pediatrics, 
      Bronx, NY, 10467, USA.
FAU - Nappo, Lynn
AU  - Nappo L
AD  - Children's Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 1 Pediatrics, 
      Bronx, NY, 10467, USA.
FAU - Pass, Robert H
AU  - Pass RH
AD  - Children's Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 1 Pediatrics, 
      Bronx, NY, 10467, USA.
AD  - Albert Einstein College of Medicine, Bronx, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20181109
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - *Cardiac Resynchronization Therapy Devices
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Fluoroscopy/*methods
MH  - Heart Defects, Congenital/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Occupational Exposure/prevention & control
MH  - Radiation Exposure/*prevention & control
MH  - Radiation Protection/*methods
MH  - Time Factors
OTO - NOTNLM
OT  - Adult congenital
OT  - Fluoroscopy
OT  - Implantable cardioverter defibrillator
OT  - Pacemaker
OT  - Pediatric
OT  - Radiation reduction
EDAT- 2018/11/11 06:00
MHDA- 2020/01/10 06:00
CRDT- 2018/11/11 06:00
PHST- 2018/10/10 00:00 [received]
PHST- 2018/10/30 00:00 [accepted]
PHST- 2018/11/11 06:00 [pubmed]
PHST- 2020/01/10 06:00 [medline]
PHST- 2018/11/11 06:00 [entrez]
AID - 10.1007/s10840-018-0479-z [pii]
AID - 10.1007/s10840-018-0479-z [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2019 Jun;55(1):93-98. doi: 
      10.1007/s10840-018-0479-z. Epub 2018 Nov 9.