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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

Joris Ector, MD^_*,_*, Octavian Dragusin, MSc, Bert Adriaenssens, MD^_*, Wim Huybrechts, MD^_*, Rik Willems, MD, PhD^_*, Hugo Ector, MD, PhD^_*,2 and Hein Heidbüchel, MD, PhD^_*,1,3

^_* Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
Department of Radiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.

Manuscript received August 31, 2006; revised manuscript received March 15, 2007, accepted March 20, 2007.

^_* Reprint requests and correspondence: Dr. Joris Ector, Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. (Email: Joris.Ector{at}uz.kuleuven.ac.be).

Objectives: This study sought to evaluate the impact of obesity on patient radiation dose during atrial fibrillation (AF) ablation procedures under fluoroscopic guidance.

Background: Obesity is a risk factor for AF and its recurrence after ablation. It increases patient radiation dose during fluoroscopic imaging, but this effect has not been quantified for AF ablation procedures.

Methods: Effective radiation dose and lifetime attributable cancer risk were calculated from dose-area product (DAP) measurements in 85 patients undergoing AF ablation guided by biplane low-frequency pulsed fluoroscopy (3 frames/s). Three dose calculation methods were used (Monte Carlo simulation, dose conversion coefficients, and depth-profile dose curves).

Results: Median DAP for all patients was 119.6 Gy·cm² (range 13.9 to 446.3 Gy·cm²) for procedures with a median duration of 4 h and 83 ± 26 min of fluoroscopy. Body mass index was a more important determinant of DAP than total fluoroscopy time (r = 0.74 vs. 0.37, p < 0.001), with mean DAP values per hour of fluoroscopy of 58 ± 40 Gy·cm², 110 ± 43 Gy·cm², and 184 ± 79 Gy·cm² in normal, overweight, and obese patients, respectively. The corresponding effective radiation doses for AF ablation procedures were 15.2 ± 7.8 mSv, 26.7 ± 11.6 mSv, and 39.0 ± 15.2 mSv, respectively (Monte Carlo). Use of conversion coefficients resulted in higher effective dose estimates than other methods, particularly in obese patients. Mean attributable lifetime risk of all-cancer mortality was 0.060%, 0.100%, and 0.149%, depending on weight class.

Conclusions: Obese patients receive more than twice the effective radiation dose of normal-weight patients during AF ablation procedures. Obesity needs to be considered in the risk-benefit ratio of AF ablation and should prompt further measures to reduce radiation exposure.

Abbreviations and Acronyms   AF = atrial fibrillation   BMI = body mass index   DAP = dose-area product   HVL = half-value layer   LAO = left anterior oblique   NRPB = National Radiological Protection Board   PSD = peak skin dose   PV = pulmonary vein   PVI = pulmonary vein isolation   RAO = right anterior oblique

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