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Electrophysiology Studies Without Fluoroscopy

Zabala, Luis M., MD; Schmitz, Michael L., MD; Ullah, Sana, MB ChB, FRCA; Watkins, W Bryan, MD; Tuzcu, Volkan, MD

Section Editor(s): Shafer, Steven L.

doi: 10.1213/01.ANE.0000227144.84027.4E
Letters to the Editor: Letters & Announcements

Division of Cardiothoracic Anesthesia; (Zabala, Schmitz, Ullah, Watkins)

Director of Electrophysiology and Pacing; Arkansas Children's Hospital; Little Rock, Arkansas

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To the Editor:

We wish to thank Dr. Katz (1) for a well-presented review of the literature and acknowledge the simplicity of a well-conducted prospective observational trial investigating radiation exposure of anesthesia personnel in an electrophysiology laboratory.

However, we would like to point out an alternative means of conducting electrophysiological studies (EPS) that avoids radiation exposure. In more than 70% of total EPS and catheter-ablation procedures performed at our institution, we safely and effectively use three-dimensional electroanatomical mapping system guidance (NavX™; St. Jude Medical, St. Paul, MN) without fluoroscopy for patients with normal cardiac anatomy and right-sided problems, such as atrioventricular (AV) node reentry tachycardia and some AV reentry tachycardia. For some procedures, for example, those requiring transseptal catheterization and those requiring mapping and ablation of pathways that cause tachyarrhythmias in patients with abnormal cardiac anatomies, we use limited fluoroscopy. But even in these instances, we use a minimal amount of fluoroscopy to place the catheter in specific locations, and we can perform most of the rest of the procedure without fluoroscopy under NavX™ guidance.

We share the same concerns as Dr. Katz regarding the radiation exposure and believe that newer non-fluoroscopic 3D electroanatomical mapping systems will significantly limit this exposure to those of us who care for these patients.

Luis M. Zabala, MD

Michael L. Schmitz, MD

Sana Ullah, MB ChB, FRCA

W. Bryan Watkins, MD

Division of Cardiothoracic Anesthesia

Volkan Tuzcu, MD

Director of Electrophysiology and Pacing

Arkansas Children's Hospital

Little Rock, Arkansas

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1. Katz JD. Radiation exposure to anesthesia personnel: the impact of an electrophysiology laboratory. Anesth Analg 2005;101:1725–6.
© 2006 International Anesthesia Research Society