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radiation exposure

FAQs A-Fib Ablations: Radiation Risks

 FAQs A-Fib Ablations: Radiation Risks 

Catheter Ablation

Catheter Ablation

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib. A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.”

Back in 2003, exposure to radioactivity during an ablation was a legitimate concern; a typical A-Fib ablation resulted in around 50 minutes of fluoroscopy time.

Today, many centers use much less or no fluoroscopy at all. Instead many use 3D non-fluoroscopy (no radiation) imaging techniques such as Intracardiac Echocardiography (ICE) and/or Magnetic Resonant Imaging (MRI). Check with your A-Fib center as to how much radiation their typical A-Fib ablation patient is exposed to, then compare it to the following points of reference to determine if you should be concerned.

TYPE OF RADIATION EXPOSURE AMOUNT (mSv units)
Average Background Radiation/year 2.4 mSv
Chest X-Ray Radiation 0.02-0.2 mSv
Full-mouth Dental X-Ray 0.03-0.2 mSv
Mammogram 0.7 mSv
Spinal X-Ray Radiation 1.5 mSv
Heart CT Scan Radiation (100-600 Chest X-rays) 12.0 mSv
25.5 min. fluoroscopy during an A-Fib Ablation 15.2 mSv

But bear in mind, even a one hour-long exposure to fluoroscopy is a relatively small risk compared to the risks of being in A-Fib, taking anti-arrhythmic meds, and/or Maze surgery.

Protecting Yourself from Radiation Damage

You can take safeguards before and after your ablation to help protect yourself from radiation damage. Since much of the cancer-causing damage from ionizing radiation is from hydroxyl free radicals, it’s recommended to take antioxidant supplements to neutralize them. A typical plan is to take the following natural supplements every six hours for at least 24 hours before and after your radiation exposure. These are available without a prescription from health food stores. But check with your doctor before taking any supplements.

1.  Vitamin C 1000 mg
2.  Lipoic Acid 400 mg
3.  N-Acetyl Cysteine 200 mg
4.  Melatonin 3 mg

Dr. Leo Galland, MD of the Foundation for Integrated Medicine suggests two additional supplements to reduce the risks of radiation exposure:

• Egb 761 (Tebonin), a Ginkgo extract to be taken a week after being exposed to imaging radiation, 120 mg daily. “Reduced the damaging effects of radiation on chromosomes—and the benefits persisted for several months after workers stopped taking it.”

• The flavonoid Hesperidin, a type of antioxidant, 250 mg about one hour before testing. “In human tests…it reduced radiation-induced damage by about one third.”

Editor’s comment: The nuclear theory that any level of radiation is cumulatively damaging may not be valid (the “Linear No Threshold” theory). The levels of radiation received during a typical catheter ablation may not be dangerous, but may even be healthful. See
Thanks to Stephanie Fagan for this question.

References
¤  Macle, L et al. “Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation.” Pacing and Clinical Electrophysiology, March 28, 2003. Volume 26, Issue 1p2, Pages 288-291.
¤  Efstathopoulos et al. “Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis.” Europace (The European Society of Cardiology), 2006 8(6): 443-448; doi:10.1093/europace/eul041
¤ Galland, Leo. Guard Against Radiation Danger. Bottom Line/Health, May 2015, p. 9.

Return to FAQ Catheter Ablations

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. “I have a defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

8. “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?

11. “Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

12. “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which if better—81 mg baby aspirin or 325 mg?

17. Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

18. “I love to exercise and I’m having a PVA. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?

20. “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.

Last updated: Thursday, September 8, 2016

Return to FAQs

Radiation Exposure During Ablation: How to Protect Yourself from Damage

Floroscopy image of catheter placement

Floroscopy image of catheter placement

By Steve S. Ryan, PhD, January 2012

Exposure to radioactivity during an ablation used to be a legitimate concern. (Doctors and nurses wore lead aprons during an ablation.) Back in 2003, a typical A-Fib ablation resulted in around 50 minutes of fluoroscopy time.1 One hour of fluoroscopy imaging is associated with a lifetime three-in-ten thousand chance (0.03%) of developing a fatal malignancy, and a risk of passing on a genetic defect of 20 per 1 million births,2These risks were considered relatively small compared to the risks of being in A-Fib, antiarrhythmic drug therapy, and/or surgery.3

Doctors follow directives which limit the amount of radiation you can be exposed to during an ablation. If you get close to exceeding these limits, they will stop the ablation (though this rarely happens).

Today Less or No Fluoroscopy

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.4 However, the radiation amount at your A-Fib center will vary depending on what type of imaging equipment they use.

Once you learn what amount of ablation radiation you might be exposed to at your A-Fib center, then you can compare it to the following to determine if you should be concerned:

TYPE OF RADIATION EXPOSURE AMOUNT (mSv units)
Average Background Radiation/year 2.4 mSv
Chest X-Ray Radiation 0.02-0.2 mSv
Full-mouth Dental X-Ray 0.03-0.2 mSv
Mammogram 0.7 mSv
Spinal X-Ray Radiation 1.5 mSv
Heart CT Scan Radiation (100-600 Chest X-rays) 12.0 mSv
25.5 min. fluoroscopy during an A-Fib Ablation 15.2 mSv

[The author did a very unscientific survey of the A-Fib medical centers in his area. The average seemed to be 10-20 minutes of fluoroscopy time [for those who used fluoroscopy] for an A-Fib ablation, but more complicated cases could expose patients to 60(+) minutes of fluoroscopy time.]

Before and After:  Protecting Yourself from Radiation Damage

You can take measures before and after your ablation to help protect yourself from radiation damage. Since much of the cancer-causing damage from ionizing radiation is from hydroxyl free radicals, it’s recommended to take antioxidant supplements to neutralize them.

Before and after your ablation, it’s recommended to take antioxidant supplements to neutralize hydroxyl free radicals.

A typical plan is to take the following natural supplements every six hours for at least 24 hours before and after your radiation exposure. These are available without a prescription from health food stores. Check with your doctor before taking any supplements.

  1. Vitamin C 1000 mg
  2. Lipoic Acid 400 mg
  3. N-Acetyl Cysteine 200 mg
  4. Melatonin 3 mg

Do Low Doses of Radioactivity Combat Cancer?

In 2004, the Journal of American Physicians and Surgeons published an amazing study of radiation exposure that calls into question the prevailing “linear no-threshold” (LNT) theory of radiation.5

But bear in mind that, even a one hour-long exposure to fluoroscopy, is a relatively small risk compared to the risks of being in A-Fib, antiarrhythmic meds, and/or surgery.

The story starts 20 years earlier in 1983 when 180 apartment building were built in Taiwan. But somehow highly radioactive Cobalt-60 was mixed into the concrete. The 10,000 people who lived in these apartments for 9-20 years received an average of 74 millesieverts (mSv) of radiation a year (a typical catheter ablation using fluoroscopy produces around 15 mSv6 but much less for non-x-ray imaging systems).

Amazingly, the cancer rates of people living in these highly radioactive buildings were 3.6% of prevailing Taiwanese rates. This is a reduction in cancer rates of 96.4%. This phenomenon is perhaps explained by the theory of hormesis which holds that intermediate levels of radioactivity actually stimulate life and improve health.

Editor’s Note: The nuclear theory that any level of radiation is cumulatively damaging may not be valid (the Linear No Threshold theory). The levels of radiation received during a typical catheter ablation may not be dangerous, but may even be healthful.

The levels of radiation received during a typical catheter ablation may not be dangerous, but may even be healthful.

Back to top

Return to Index of Articles: Catheter Ablation

Last updated: Tuesday, August 23, 2016

 

References    (↵ returns to text)

  1. Macle, L et al. “Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation.” Pacing and Clinical Electrophysiology, March 28, 2003. Volume 26, Issue 1p2, Pages 288-291.
  2. Shapira, AR. “Catheter Ablation of Supraventricular Arrhythmias and Atrial Fibrillation.” American Family Physician, November 15, 2009, p. 1089. http://www.aafp.org/afp/2009/1115/p1089.html
  3. Calkins, H. et al. “Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections.” Circulation, Vol. 84, 2376-2382, 1991.
  4. Shapira, A R. Catheter Ablation of Supraventricular Arrhythmias and Atrial Fibrillation. American Family Physician, November 15, 2009, p. 1089. http://www.aafp.org/afp/2009/1115/p1089.html.
  5. Chen, W. et al. Is Chronic Radiation an Effective Prophylaxis Against Cancer? Journal of American Physicians and Surgeons, Spring 2004 Vol 9, Issue 1, p6. Last accessed Sept. 13, 2012 http://www.jpands.org/jpands0901.htm
  6. Efstathopoulos, EP, et al. “Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis.” Europace (The European Society of Cardiology), 2006 8(6): 443-448; doi:10.1093/europace/eul041

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