Safety and feasibility of a 1 frame-per-second X-ray framerate in cardiac electrophysiology

Background: We investigated the feasibility and safety of a framerate of 1 frame per second (“fps”) for fluoroscopy and cine-angiography, to lower radiation exposure for patients and personnel in cardiac electrophysiology (“EP”). Method: Analysis of 2521 EP procedures, 899 (36%) with the lowest available conventional framerate (3.75 fps) and 1622 (64%) procedures performed with a framerate lowered further to 1.0 fps (by looping a 1 Hz square pulse to the ECG trigger) performed between 01/2016 and 01/2020. Results: Procedures performed with 1.0 fps had the same acute procedural success rates (p = 0.20) and adverse event rates (p = 0.34) as the 3.75 fps group. There was no difference in total X-ray operation time (p = 0.40). The dose-area-product (DAP) was significantly reduced from 638 to 316 cGy*cm² (p < < 0.0001) for all procedure types together, and for each subgroup. In a multivariable linear regression model, total X-ray operation time (estimate 38 cGy*cm² /min) and body mass index (estimate 32 cGy*cm² / index point) and a framerate of 1.0 fps (−314 cGy*cm² against 3.75 fps) were independent predictors of a lower DAP (p-value of t-statistic for all << 0.0001). Conclusions: A framerate of 1.0 fps is safe and feasible in cardiac electrophysiology procedures. It was associated with a significant reduction of radiation exposure for patient and personnel.