http://circ.ahajournals.org/content/110/19/3003.long

I didn't read it but the answers are there.

petey

Once again, thanks for your great researching skills, Petey!

I know that ignorance is NOT bliss, but I'm glad I hadn't read this 3 weeks ago and ratcheted the anxiety level up even more, although I'd still have decided to go through with it. One more reason to be thankful that my ablation was relatively short in duration (not sure that means any less radiation exposure?). I guess like so many others things, you have to balance the benefits against the risks.

It will be nice to see what they do to lessen the risk in the future.

Agreed, Bereth!

heart2222,

The ablation technology has changed tremendously. The article that petey posted is very old , it is from a study in 2004. However, even in this article, they concluded that the exposure to the patient was minimal.

Your concern was the 1st question I asked my EP before my ablation in December 2013. He said, they use x-ray only for the first 15 to 20 minutes of the procedure to map the heart . Then, everything is done by magnetic field and computers. He added, all catheters are magnetic sensitive so they can see the position of the catheter via a magnetic field at all times. As a result, with the new equipment, the patient and the EP get very little radaition compare to a few years back.

Also, with the new digital technology imaging, the amount of radiation that you get from x-rays these days, is far less than before. That said, I still avoid to get a CT-scan if possible since CTs can still give you lots of radiation because of the way they are done.

When was your ablation? How many years ago?

I am very concerned about getting CTs and X-rays too. That was my biggest concern about ablation, which turned out to be a false concern (fortunately).

Scott

Hmmm. My ablation was in 2012. I asked about the radiation at the time and it did seem to be a concern.that when he said I would get 1/4 gray. That is a LOT of radiation!!

I asked another EP about it and he said it's not a problem if you have one, but if you have more than one, it becomes an issue.

I really don't know...

Hi heart2222

Well, please bear in mind that the equipment for ablation has changed a lot since 2012. That is the nature of technology, things are changing very fast. Just look at your cell phone and laptops.

Now, even your regular x-ray machines give you far less radiation than a few years ago since they are mostly digital.

However, it is possible that some hospital are still using old equipment for ablation because of the cost.

Before his ablation, Paul (Paul60) was talking about the equipment (the name and the model # ) which they would use during his ablation. That is what most hospitals use which results in far less radiation than older equipment. The new equipment use only magnetic field to show the position of the catheter rather than x-ray. X-ray is only used to map the heart for the first 20 minutes of the procedure.

So, please don't worry about the radiation if you have to go for another ablation. Also, please ask your EP about equipment in the hospital where he performs the procedure.

Also, I am thinking your EP was probably kidding you about the amount of radiation and the fact that it will make you gray. Remember, he is standing next to you and he will be exposed to it too. They do one or two ablation every day. So, what he said was true, EPs should be glowing and walking with a HALO around them, LOL. Right?

Of course, you can always just thank engineers for making life safer, easier, and more fun :-)

Paul - Do you remember the equipment name in your hospital where you got your ablation? I looked it up at the time but I did not bookmark it.

Scott

I had mine done at the Cleveland Clinic, I would hope their equipment was up-to-date. Grays are a measurement of radiation. He did tell me that I did receive quite a bit.

The EP's do wear that protective clothing like radiologist wear.

I guess my concern is that radiation is cumulative. So whatever I got is with me for the rest of my life!!

Scott,

It is very reassuring that they are using much less radiation now. (wish they could have 2 years ago. Ha!) Technology does come a long way in a short period of time.

Thanks!

Hi heart,

I know what you are saying about 2 years ago. But, based on the link that petey posted, really, the radation amount even in 2004 was not that much compare to other stuff like CT scan. Here is another more recent article that I found, which is interesting too. Here is a part of it:

But many centers today use much less or no fluoroscopy at all. Instead many use 3D non-fluoroscopy (no radiation) imaging techniques such as Intracardiac Echocardiography (ICE), and Magnetic Resonant Imaging (MRI). You need to check with your A-Fib center as to how much radiation their typical A-Fib ablation patient is exposed to. The radiation dose for a typical A-Fib ablation is estimated to be 18.4 mSv. 2 However, the radiation amount at your A-Fib center will vary depending on what type of imaging equipment they use. -

Here is the link to the entire article :
http://a-fib.com/treatments-for-atrial-fibrillation/catheter-ablation/ablation-procedure-and-radiation-exposure/#sthash.i1TtXK9H.dpuf

I wished I knew what to do before and after ablation to minimize the effect of radiation before my ablation.

You have brought up a very excellent point about the radiation from the ablation. I hope other members going for ablation read this link and find out about the equipment in their hospital.

By the way, just like you, I am very careful about radiation. After my ablation, the next day, I had a lot of pain in my chest. I asked for ibuprofen, they did NOT give it to me. Instead the hospital cardiologist, ordered a CT scan of my lungs for blood clot. I refused to go for it. It was a big deal. All the nurses and some other doctors were trying to convince me to go for the CT scan. I told them I do NOT have blood clot and I want to try ibu first.

Well, finally, the hospital PCP doctor (a young one), authorized the ibuprofen injection. Withing 5 minutes, the pain was gone. She told me I do NOT have blood clot in my lungs and that was the reason the ibu worked. To be safe, she ordered ultrasound of my legs for blood clot, which showed nothing. Talking about a "Happy Ending", LOL.

The hospital PCP doctor was just like you and I, very careful about radiation. She said the recent research has shown radiation can cause cancer and it is very serious. But, the hospital cardiologist (an older guy) was very angry at me and the other doctor. He gave me a lecture for 20 minutes why the radiation from the CT scans and ablation is nothing compare to what I get from the every day sun and flying in the jetliners.

Well, I was just glad that he was NOT my cardiologist. By the way, during this whole ordeal, my EP was on Xmas vacation :-) The EP was the guy who told me if I had chest pain, just ask for ibuprofen, but he did not apparently told anybody else :-( Such is life, I am glad I survived it and I did not bend under pressure to get the chest CT scan, which was lots of radiation.

Scott

Wow, thanks Scott for your lengthy post. It sounds so great!! But I got the surgical report on my ablation and it says I received 1/4 gray which I calculated to equal 120 CT scans. Before I had the ablation, I brought it up to him and he agreed, the pt does receive a lot of radiation. I went to a talk on a fib ablations from another doctor and he said the radiation from one ablation is ok, repeated ablations add up.

I totally agree with your concern about radiation. I had an ENT who wanted to do a CT on my brain for something. I told him NO. I even try to avoid chest x-rays if there isn't any sure fire reason to do one. All that is cumulative. i had a CT of the heart before the procedure. They wanted to repeat it I think 6 mos afterwards. I requested an MRI instead. I asked for an MRI ahead of time, but the doc said it isn't as accurate for the info he needs.

I don't know how to get to the bottom of my actual radiation exposure. The articles you and petey are posting say not that much. But my ablation report says otherwise. Hmmm...

I hope YOU are right!!

Thanks for the info!

i had motrin after my ablation also due to severe chest pains. I was still on Pradaxa, so that made me a little nervous since the Motrin was in high doses. They know what they are doing though!!

Ultrasound and 3D Mapping Reduce Radiation Exposure and Increase Patient Outcomes

"To guide our way during this procedure, we create highly accurate 3D maps of the heart based on ultrasound images. Then we monitor where the catheters are and make sure blood clots arent developing. We can identify potential problems early to make sure the procedure is safe. Using ultrasound has an added advantage. We are far less dependent on the traditional use of X-rays to see inside the heart, meaning radiation exposure is dramatically reduced."

http://www.jaxhealth.com/services/afib/procedures/ultrasound-and-3d-mapping-reduce-radiation-exposure/





Background: Catheter ablation is the treatment of choice for most forms of SVT. Traditionally, fluoroscopy has been the primary tool for visualizing catheter position. However, newer, 3-dimensional mapping technologies offer multiple options for minimizing fluoroscopy use. We review our 8 year experience of a zero-fluoroscopy approach using the Ensite system, and discuss our current techniques.

Methods: From January 2006 to October 2013, we performed 524 catheter ablation procedures with a zero-fluoroscopy approach. The Ensite system was used exclusively. Early in the study, NavX mode was employed. In the later time period, Velocity mode was used. The Ensite system allowed easy access to all right sided arrhythmias. For left sided arrhythmias, TEE was added to aid with transseptal puncture.

Results: Reviewing 524 consecutive procedures, mean age was 14 years (range 7 weeks to 65 years). Mean weight was 60.7 kg (range 3 to 174 kg). Mean procedure time was 142 minutes (range 42 402 minutes). There were no complications. Twenty -five patients required the use of fluoroscopy, mostly as part of simultaneous diagnostic or interventional cath procedures. There was only one instance in which fluoroscopy was used when not anticipated at the start of the procedure. With this data available, and seeing that fluoroscopy is rarely needed unexpectedly, we hypothesized that catheter ablation no longer requires a traditional cath lab. We present our early approach to ablation outside the catheterization lab.

Conclusion: Three dimensional mapping systems can eliminate fluoroscopy use in virtually all routine ablation procedures. As technology improves, ablation procedures will shift beyond the traditional cath lab.

http://www.jafib.com/published/published.php?cont=abstract&id=1066


petey

Hi heart,

What you said was pretty scary regarding that you got equivalent of 120 Ct scans. I did a little bit of searching. For 1/4 GY that you got, I came up with equivalant of about 20.8 CT scans. Still it does not look good either. But, it is better than 120 CTs.

1/4GY = .25 Gy (Gray) = 250 mGy (milli-Gray) = 250 mSv (milli-Sievert)

Note - For X-rays and Gamma-rays, the Gray value is the same as
Sievert. But, for Alpha-particles, one Gray is equivalent to 20 Sieverts. I am assuming the worst, all radiation is in form of X-rays and Gamma-rays. So, one Gray is equivalent to one Sievert.

Now, according to the link in my previous post, each heart CT scan is about 12 mSv. So, 250 (mSv) / 12 mSv) = 20.8 Heart CT scans.

May be I am missing something in my calculations above. If so, please let me know. However, in my opinion, it is still to much radiations for one ablation. Hopefully, Cleveland Clinic has changed their equipment to more modern ones with 3 D mapping and alike by now. Here is a link to convert Gray to Sievert:

http://en.wikipedia.org/wiki/Gray_(unit)

petey,
Thanks for the link. But, the problem comes down to MONEY. More than likely, the new imaging equipment for ablation are very expensive. The question is if the hospitals are willing to spend the capital to update their imaging equipment and provide the patients with safer procedures.

In my view, with so little money that the hospitals are getting from the insurance companies, it will be very hard for hospitals to spend a lot of capital for equipment update. Bottom line, again, the insurance companies (for PROFIT middle entities) are the problem. I am NOT trying to get off the subject, but trying to point out what can be the main reason that prevents the hospitals from switching to more modern imaging equipment for ablation. The problem does NOT seem to be the unavailability of technology but it is the lack of capital and resources in the hospitals because of low payout by the insurance companies. Make sense?

Scott

Scott: Makes sense. All the more reason to go to a top EP and ask the right questions. If I ever have an ablation, I'm not going to Walmart or a teaching hospital at a 2 year community college. petey

Scott,
THanks for researching this. I LIKE your answer better with 20.8 CT scans. As you said, that is still a lot, but not as bad as 120 times.

Here is how i calculated mine. I have a radiologist friend whom I emailed. She told me:

1 gray=100 mrads
CAT scan of the brain=200 mrads=0.2 rads
My fluoroscopy of 1/2 gray=25 rads.

Thus 25 rads= x (0.2)
x= 125.

So I concluded my ablation gave me 125 times what a normal CT of the brain would give me.

Is my math correct?

It still bothers me greatly that I received that much radiation.

Again, I like your numbers better!!

Thanks for looking into this.

Thanks, Petey for the article too.