Patient radiation dose during fluoroscopically guided biventricular device implantation

Objective Implantation of biventricular devices (BiV) with a transvenous left ventricular lead is complex requiring a significant fluoroscopy time and radiation dose. In the United Kingdom, the Health Protection Agency (HPA) collects data regarding radiographic procedures and sets national diagnostic reference levels (DRL) at the 75th percentile of the distribution of doses for a wide range of procedures. Insufficient data were returned to the HPA to allow them to set DRL for BiV devices at the last publication in 2010. Due to the large variation in data available and small datasets for BiV procedures we aimed to collect a large dataset to guide standards for implantation. Methods We collected retrospective data (fluoroscopy time and radiation dose [DAP]) for new BiV devices for the three years 2009 - 2011 from three high volume tertiary centres in the North West of England. Databases were scrutinised to ensure the quality of the data. Results From a total of 1374 implants we identified data for 1319 patients for fluoroscopy time and 1316 for DAP. The mean fluoroscopy time for all three centres combined was 18.7 +/- 0.3 mm. The 756 percentile fluoroscopy time for the combined data was 24.2 min. The mean DAP for the three centres combined was 25.1 +/- 1.3 Gy cm(2). The 75th percentile DAP for the combined data was 27.7 Gy cm(2). Conclusions We present a large dataset of new biventricular device implants, based on the 75th percentile data we suggest a DRL of 24.2 min and 27.7 Gy cm(2).