Acute radiodermatitis after radiofrequency catheter ablation

doi:10.1016/S0190-9622(97)70047-1

Journal of the American Academy of Dermatology

Volume 36, Issue 5, Supplement, May 1997, Pages 881-884

https://doi.org/10.1016/S0190-9622(97)70047-1 Get rights and content

Abstract

Radiofrequency (RF) catheter ablation is used in the treatment of a variety of arrhthymias. This report describes the development of acute radiodermatitis after two prolonged RF catheter ablation procedures for supraventricular tachycardia. It also reviews the characteristics and treatment of radiation-induced skin reactions. (J Am Acad Dermatol 1997;36:881-4.)

Section snippets

Case 1

A patient with a supraventricular tachycardia underwent RF catheter ablation. The procedure was technically difficult and lasted several hours. One hundred and ninety cumulative minutes of fluoroscopic imaging time using a continuous fluoroscopic system with automatic brightness control (manufactured by General Electric) was required. Throughout the study a cutaneous electrical dispersion pad was kept on the left lower back, and defibrillator pads were placed on the anterior and posterior

DISCUSSION

Cardiovascular complications associated with catheter ablation techniques are the most common. Cutaneous side effects have been reported infrequently. Hematomas from vascular injury ¹⁰ and a mild chest wall burn at the ground patch site ⁸ have been described.

Recently, radiation-induced skin injuries from prolonged fluoroscopic exposure during interventional cardiac procedures have been reported. 11, 12

Inflammation of the skin, adnexal structures, and subcutaneous tissues after radiation

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Incidence of Chronic Radiodermatitis after Fluoroscopically Guided Interventions: A Retrospective Study
2019, Journal of Vascular and Interventional Radiology
To assess the incidence and risk factors for chronic radiodermatitis after fluoroscopically guided interventions (FGIs) in high-risk patients.
Between 2010 and 2016, of 55,782 patients who underwent FGIs, 359 had a risk procedure for skin injury (maximal skin dose > 3 Gy, air kerma > 5 Gy, dose area product [DAP] > 500 Gy.cm², or fluoroscopy time > 60 minutes). Ninety-one of these patients were examined by a dermatologist for radiodermatitis (median time after procedure, 31.2 months [95% confidence interval, 14.2–50.7]). In each case, the clinical features and topography of the skin lesions were recorded and their incidence calculated. The characteristics of the patients and of the FGIs were tested as risk factors.
Eight patients (8.8%) had chronic radiodermatitis; 19 (20.9%) had acute radiodermatitis. Body mass index, DAP value, and air kerma were the only risk factors identified.
This study shows that chronic radiodermatitis may be considered a frequent side effect in an at-risk population. The lesions are commonly benign, but extensive sclerosis can occur. Patients should be better informed about the side effects and offered a skin exam periodically.
Atrial Fibrillation Ablation: Do We Really Need Preprocedural Imaging?
2012, Cardiac Electrophysiology Clinics
Citation Excerpt :
Catheter ablation of AF is often a complex and long procedure requiring long fluoroscopy exposure time and often preceded and followed by CT scans. An important, less easily recognized, and rarely considered potential complication of AF ablation is the delayed effect of the radiation received by the patients, including acute and subacute skin injury,53,54 malignancy, and genetic abnormalities.53 Radiation exposure during AF ablation has been evaluated by Lickfett and colleagues.55
2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design
2012, Heart Rhythm
Reactions to physical agents
2009, Weedon's Skin Pathology: Third Edition
Flat Detectors and New Aspects of Radiation Safety
2009, Cardiology Clinics
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In most cases, dose is used to suppress the electronic noise that is inherent in digital flat detectors.10 Although a decade has passed since the US Food and Drug Administration (FDA) Center for Devices and Radiological Health first issued its advisory warning to health care institutions about the risk of radiation burns from fluoroscopy,11 injuries continue to occur in increasing numbers.12–17 Federal regulations governing the maximum allowable dose rate for fluoroscopy in the United States have not eliminated the risk of serious skin burns.18
Flat detectors are the heart of high-performance imaging systems that provide new capabilities as well as new hazards. The superior image quality enables operators to work with heavier patients and steeper projections. Under these conditions, exposure control computers automatically increase the production of x-rays to compensate for absorption by body tissues. Image quality is preserved, and operators may not be aware of the very high skin doses delivered during prolonged procedures. Although it is assumed that flat detector systems are safe, the potential for radiation overexposure and skin injury is real. This article examines the unique radiation hazards of flat detector fluoroscopy and suggests practical steps that clinicians can take to protect themselves and their patients from radiation injury.
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2008, Journal of Vascular and Interventional Radiology
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Vascular interventions have recently spread quickly and achieved success in the treatment of various diseases. Paralleling this, radiation skin injuries such as ulcer and epilation have come to be increasingly reported (5–10). Therefore, estimation of the skin dose patients receive during interventional radiologic procedures and prevention of radiation skin injuries are important.
To measure the entrance surface dose (ESD) during three-dimensional (3D) imaging of a phantom and evaluate a method to estimate ESD with use of dose–area product (DAP) values.
The present study used an angiographic unit with a digital flat-panel system for 3D imaging. DAP values and ESDs were evaluated on square phantoms with thicknesses of 12.0, 15.0, 18.0, 21.0, and 25.0 cm with use of 5-second acquisitions. ESDs were measured on the lateral and posterior surfaces of the square phantom. DAP values and ESDs were also evaluated on a human-shaped phantom with various table heights, with ESDs measured on the phantom surfaces on the posterior centerline, right middle axillary line, and their midpoint.
The posterior ESDs were 7.3 mGy, 12.1 mGy, 18.8 mGy, 26.9 mGy, and 38.5 mGy for the square phantoms with thicknesses of 12 cm, 15 cm, 18 cm, 21 cm, and 25 cm, respectively. The DAP and the posterior ESDs were correlated (r = 0.998, P < .0001). The regression equation was D = DAP × 0.0014, where D was the posterior ESD (mGy). For the human-shaped phantom, the posterolateral ESD tended to be slightly larger than the posteromedial ESD, with the differences less than 10%. The estimated doses based on this relationship were almost equal to the actual posterolateral doses for each table height.
The ESD of a single 3D imaging study was considerably lower than the thresholds for radiation skin injuries. The DAP values are useful to estimate the maximum patient ESD during 3D imaging.

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^☆: Reprint requests: George T. Nahass, MD, Department of Dermatology, St. Louis University Health Sciences Center, 1402 S. Grand Blvd. St. Louis, MO 63104.

^☆☆: 0190-9622/97/$5.00 + 0 16/4/80727

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Acute radiodermatitis after radiofrequency catheter ablation☆,☆☆

Abstract

Section snippets

Case 1

DISCUSSION

J Am Coll Cardiol

J Am Coll Cardiol

J Am Acad Dermatol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Catheter ablation of the atrioventricular junction with radiofrequency energy

Circulation

Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current

N Engl J Med

Single-catheter approach to radiofrequency current ablation of left-sided accessory pathways in patients with Wolff-Parkinson-White syndrome

Circulation

Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients abbreviated therapeutic approach to Wolff-Parkinson-White syndrome

Circulation