The DOI matches its Crossref record; 42 of the 42 references it cites were found in a registry or an index.
Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation
Open accessAbstract
Objectives This study sought to evaluate the impact of obesity on patient radiation dose during atrial fibrillation (AF) ablation procedures under fluoroscopic guidance. Background Obesity is a risk factor for AF and its recurrence after ablation. It increases patient radiation dose during fluoroscopic imaging, but this effect has not been quantified for AF ablation procedures. Methods Effective radiation dose and lifetime attributable cancer risk were calculated from dose-area product (DAP) measurements in 85 patients undergoing AF ablation guided by biplane low-frequency pulsed fluoroscopy (3 frames/s). Three dose calculation methods were used (Monte Carlo simulation, dose conversion coefficients, and depth-profile dose curves). Results Median DAP for all patients was 119.6 Gy x cm2 (range 13.9 to 446.3 Gy x cm2) for procedures with a median duration of 4 h and 83 +/- 26 min of fluoroscopy. Body mass index was a more important determinant of DAP than total fluoroscopy time (r = 0.74 vs. 0.37, p < 0.001), with mean DAP values per hour of fluoroscopy of 58 +/- 40 Gy x cm2, 110 +/- 43 Gy x cm2, and 184 +/- 79 Gy x cm2 in normal, overweight, and obese patients, respectively. The corresponding effective radiation doses for AF ablation procedures were 15.2 +/- 7.8 mSv, 26.7 +/- 11.6 mSv, and 39.0 +/- 15.2 mSv, respectively (Monte Carlo). Use of conversion coefficients resulted in higher effective dose estimates than other methods, particularly in obese patients. Mean attributable lifetime risk of all-cancer mortality was 0.060%, 0.100%, and 0.149%, depending on weight class. Conclusions Obese patients receive more than twice the effective radiation dose of normal-weight patients during AF ablation procedures. Obesity needs to be considered in the risk-benefit ratio of AF ablation and should prompt further measures to reduce radiation exposure.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Obesity has also been linked to a higher radiation dose and complication rate during AF ablation.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [302]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Recommendations of the International Commission on Radiological Protection
(1961) · Postgraduate Medical Journal · doi:10.1136/pgmj.37.425.168-b · Cited by 5,868
The 2007 recommendations of the International Commission on Radiological Protection
Valentin, J. (2007) · Elsevier eBooks · Cited by 4,105
Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y.-H., Klein, G., Natale, A., Packer, D., et al. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.859116 · Cited by 2,852
(1998) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/68.4.899 · Cited by 2,722
Health Risks from Exposure to Low Levels of Ionizing Radiation:: BEIR VII Phase 2
Earth, D. O. (2006) · CERN Document Server (European Organization for Nuclear Research) · Cited by 2,190
Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study
Heeringa, J., van der Kuip, D. A. M., Hofman, A., Kors, J. A., van Herpen, G., Stricker, B. H. C., Stijnen, T., Lip, G. Y. H., & Witteman, J. C. M. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi825 · Cited by 1,939
Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know
Brenner, D. J., Doll, R., GOODHEAD, D. T., Hall, E. J., Land, C. E., Little, J. B., Lubin, J. H., Preston, D. L., Preston, R. J., Puskin, J. S., et al. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2235592100 · Cited by 1,765
Recommendations of the International Commission on Radiological Protection
International Commission on Radiological Protection (1959) · Health Physics · doi:10.1097/00004032-195901000-00001 · Cited by 1,706
Obesity and the risk of new-onset atrial fibrillation
Wang, T. J. (2004) · JAMA · doi:10.1001/jama.292.20.2471 · Cited by 1,427
Cappato, R., Calkins, H. G., Chen, S., Davies, W. D., Iesaka, Y., Kalman, J. M., Kim, Y.-H., Klein, G. J., Packer, D. L., & Skanes, A. C. (2005) · Circulation · doi:10.1161/01.cir.0000157153.30978.67 · Cited by 1,303
Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice
Hausleiter, J., Meyer, T. S., Hadamitzky, M., Huber, E., Zankl, M., Martinoff, S. A., Kastrati, A., & Schömig, A. (2006) · Circulation · doi:10.1161/circulationaha.105.602490 · Cited by 702
Fluoroscopy: Patient Radiation Exposure Issues
Mahesh, M. (2001) · Radiographics · doi:10.1148/radiographics.21.4.g01jl271033 · Cited by 411
Hirao, K., Otomo, K., Wang, X., Beckman, K. J., McClelland, J. H., Widman, L. E., Gonzalez, M. D., Arruda, M. S., Nakagawa, H., Lazzara, R., et al. (1996) · Circulation · doi:10.1161/01.cir.94.5.1027 · Cited by 279
Hart, D. B., Jones, D., & Wall, B. F. (1994) · OpenGrey (Institut de l'Information Scientifique et Technique) · Cited by 277
Coles, D. R., Smail, M. A., Negus, I. S., Wilde, P. J., Oberhoff, M., Karsch, K. R., & Baumbach, A. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.11.078 · Cited by 263
Radiation Exposure During Catheter Ablation of Atrial Fibrillation
Lickfett, L., Mahesh, M., Vasamreddy, C., Bradley, D., Jayam, V., ELDADAH, Z. A., Dickfeld, T. M., Kearney, D., Dalal, D., Lüderitz, B., et al. (2004) · Circulation · doi:10.1161/01.cir.0000146952.49223.11 · Cited by 236
Tubiana, M. (2005) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2005.06.013 · Cited by 224
Mathematical Phantoms Representing Children of Various Ages for Use in Estimates of Internal Dose
USDOE, Cristy, M., & USNRC (1980) · doi:10.2172/5308345 · Cited by 168
Preliminary reference levels in interventional cardiology
Neofotistou, V., Vano, E., Padovani, R., Kotre, J., Dowling, A., Toivonen, M., Kottou, S., Tsapaki, V., Willis, S., Bernardi, G., et al. (2003) · European Radiology · doi:10.1007/s00330-003-1831-x · Cited by 159
Organ Dose Calculation in Medical X Ray Examinations by the Program PCXMC
Servomaa, A., & Tapiovaara, M. J. (1998) · Radiation Protection Dosimetry · doi:10.1093/oxfordjournals.rpd.a032509 · Cited by 148
Flat-panel detectors: how much better are they?
Seibert, J. A. (2006) · Pediatric Radiology · doi:10.1007/s00247-006-0208-0 · Cited by 147
Estner, H., Deisenhofer, I., Luik, A., Ndrepepa, G., von Bary, C., Zrenner, B., & Schmitt, C. (2006) · EP Europace · doi:10.1093/europace/eul079 · Cited by 146
Rotter, M., Takahashi, Y., Sanders, P., Haı̈ssaguerre, M., Jaı̈s, P., Hsu, L., Sacher, F., Pasquié, J., Clémenty, J., & Hocini, M. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi172 · Cited by 141
Perceptual comparison of pulsed and continuous fluoroscopy
Aufrichtig, R., Xue, P., Thomas, C. W., Gilmore, G. C., & Wilson, D. L. (1994) · Medical Physics · doi:10.1118/1.597285 · Cited by 131
X-ray dose and associated risks from radiofrequency catheter ablation procedures
McFadden, S. L., Mooney, R. B., & Shepherd, P. (2002) · British Journal of Radiology · doi:10.1259/bjr.75.891.750253 · Cited by 123
Right Atrial Angiographic Evaluation of the Posterior Isthmus
Heidbüchel, H., Willems, R., van Rensburg, H., Adams, J., Ector, H., & de Werf, F. V. (2000) · Circulation · doi:10.1161/01.cir.101.18.2178 · Cited by 121
Self-citationKuon, E., Glaser, C. E., & Dahm, J. B. (2003) · British Journal of Radiology · doi:10.1259/bjr/82051842 · Cited by 116
Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation
Macle, L., Weerasooriya, R., Jaı̈s, P., Scavée, C., Raybaud, F., Choi, K., Hocini, M., Clémenty, J., & Haı̈ssaguerre, M. (2003) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2003.00034.x · Cited by 86
The impact of cardiology on the collective effective dose in the North of England.
Broadhead, D. A., Chapple, C.-L., Faulkner, K., Davies, M. L., & McCallum, H. M. (1997) · British Journal of Radiology · doi:10.1259/bjr.70.833.9227231 · Cited by 84
EFSTATHOPOULOS, E. P., Katritsis, D. G., Kottou, S., Kalivas, N., Tzanalaridou, E., Giazitzoglou, E., Korovesis, S., & Faulkner, K. (2006) · EP Europace · doi:10.1093/europace/eul041 · Cited by 76
Dose conversion coefficients for interventional procedures
Schultz, F. W., & Zoetelief, J. (2005) · Radiation Protection Dosimetry · doi:10.1093/rpd/nci753 · Cited by 47
Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases
Aerts, A., Decraene, T., van den Oord, J., Dens, J., Janssens, S., Guelinckx, P. J., Flour, M., Degreef, H. J., & Garmyn, M. (2003) · Journal of the European Academy of Dermatology and Venereology · doi:10.1046/j.1468-3083.2003.00687.x · Cited by 45
Hansson, B., & Karambatsakidou, A. (2000) · Radiation Protection Dosimetry · doi:10.1093/oxfordjournals.rpd.a033104 · Cited by 44
Computing patient doses of X-ray examinations using a patient size- and sex-adjustable phantom.
Rannikko, S., Ermakov, I., Lampinen, J. S., Toivonen, M., Karila, K. T., & Chervjakov, A. (1997) · British Journal of Radiology · doi:10.1259/bjr.70.835.9245883 · Cited by 44
Davies, A. G., Cowen, A. R., Kengyelics, S. M., Moore, J., & Sivananthan, M. U. (2006) · European Radiology · doi:10.1007/s00330-006-0458-0 · Cited by 35
Influence of Flat-Panel Fluoroscopic Equipment Variables on Cardiac Radiation Doses
Nickoloff, E. L., Lu, Z. F., Dutta, A., So, J. C., Balter, S., & Moses, J. W. (2007) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-006-0096-6 · Cited by 29
Heidbüchel, H., Ector, H., Adams, J., & de Werf, F. V. (1997) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1997.tb00998.x · Cited by 22
Self-citationAblation of Focally Induced Atrial Fibrillation:
Dilling-Boer, D. M., MERWE, N. V. D., ADAMS, J., Foulon, S., Goethals, H., Willems, R., Ector, H., & Heidbüchel, H. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.03385.x · Cited by 13
Self-citationHepatoblastoma: why so many low-birth-weight infants?
Slovis, T. L., & Roebuck, D. J. (2006) · Pediatric Radiology · doi:10.1007/s00247-006-0128-z · Cited by 13
Use of a Non-Fluoroscopic Catheter Navigation System for Pulmonary Vein Isolation
Wood, M. A., Christman, P. J., Shepard, R. K., & Ellenbogen, K. A. (2004) · Journal of Interventional Cardiac Electrophysiology · doi:10.1023/b:jice.0000019271.94331.47 · Cited by 12
Lakkireddy, D., Blake, G. E., Patel, D., Rotter, M., Verma, A., Ryschon, K. L., Khan, M., Schweikert, R. A., Haı̈ssaguerre, M., & Natale, A. (2008) · Journal of Atrial Fibrillation · doi:10.4022/jafib.v1i1.414 · Cited by 10
Lakkireddy, D., Patel, D., Rotter, M., Haı̈ssaguerre, M., Verma, A., Thal, S. G., Wazni, O. M., Kanj, M. H., Khan, M., Kılıçaslan, F., et al. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.02.606 · Cited by 1
Research works printed but not linked: 1
- Leysen, 2006, The influence of patient thickness on the calculation of organ doses and effective dose, Radioproteccion, 8, 59
Cited by
Sorted by citations
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström‐Lundqvist, C., Boriani, G., Castella, M., Dan, G.-A., Dilaveris, P., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa612 · Cited by 10,550
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
Self-citationCalkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.012 · Cited by 2,794
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Europace · doi:10.1093/europace/eus027 · Cited by 2,722
Metadata
- Authors
- Ector, J., Dragusin, O., Adriaenssens, B., Huybrechts, W., Willems, R., Ector, H., & Heidbüchel, H.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Corresponding author
- Ector, Joris
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-07
- Volume
- 50
- Issue
- 3
- Pages
- 234-242
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2059492469
- Cited by
- 201
- References
- 42
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 6 · 2021: 9 · 2020: 15 · 2019: 16 · 2018: 15 · 2017: 20 · 2016: 17 · 2015: 15 · 2014: 10 · 2013: 6 · 2012: 13
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
- Keywords
- obesity, radiation dose, atrial fibrillation, pulmonary vein isolation, fluoroscopy, effective dose, body mass index, dose-area product, radiation dose reduction, catheter ablation
- MeSH terms
- Adult, Analysis of Variance, Atrial Fibrillation, Dose-Response Relationship, Radiation, Electrocardiography, Female, Fluoroscopy, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Probability, Pulmonary Veins, Radiation Dosage, Severity of Illness Index, Cohort Studies, Radiography, Interventional, Body Mass Index, Survival Analysis, Treatment Outcome, Catheter Ablation, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
