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X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart

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Abstract

The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00–14.00) to 26.33 (IQR 8.77–140.84) cGycm2. ED median was between 23.18 (IQR 5.21–67.70) to 60.96 (IQR 20.64–394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia—27.65 (IQR 12.91–75.0) cGycm2 and 100.73 (IQR 53.31–258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81–76.0) cGycm2 and ED 103.15 (IQR 60.78–266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.

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Abbreviations

3D:

Three-dimensional

AT:

Atrial tachycardia

AP:

Accessory pathways

CF:

Conversion factor

DAP:

Dose area product

ED:

Effective dose

Gy:

Gray

IQR:

Interquartile range

MS:

Mapping system

Sv:

Sievert

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. University of Zagreb, School of Medicine, Zagreb, Croatia

    Nikola Krmek, Diana Delić-Brkljačić, Milan Milošević, Mirta Rode & Vjekoslav Radeljić

  2. Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary

    László Környei & Flóra Kocsis

  3. Dubrava University Hospital, Zagreb, Croatia

    Ivana Kralik

Authors
  1. Nikola Krmek
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  2. László Környei
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  3. Ivana Kralik
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  4. Diana Delić-Brkljačić
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  5. Milan Milošević
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  6. Mirta Rode
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  7. Flóra Kocsis
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  8. Vjekoslav Radeljić
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Contributions

NK analyzed the data, performed literature search, and wrote the manuscript; LK gave the idea for the study and helped in writing the manuscript; IK oversaw the project and helped in writing the manuscript; DDB oversaw the project and helped in writing the manuscript; MM performed the statistical analysis and analyzed the data; MR and FK contributed to the data collection and literature search; and VR oversaw the project, helped in writing the manuscript, and analyzed the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nikola Krmek.

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Competing interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been reviewed and approved by ethics committees in Croatia (Ethics committee, University hospital center Sestre milosrdnice—registry number 251-29-11-21-05) and in Hungary (Health Science Council, Scientific and Research Ethics Committee, ETT TUKEB—registry number BMEÜ/3824-3/2022/EKU).

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Krmek, N., Környei, L., Kralik, I. et al. X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart. Pediatr Cardiol 45, 804–813 (2024). https://doi.org/10.1007/s00246-024-03428-6

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