Research summary, narrative review, 2023

Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review

Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, et al.. Europace. 2023

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In plain language

This EHRA review reports that ultra low-dose fluoroscopy settings, collimation, low frame rates, shielding and 3D mapping or intracardiac echo can greatly reduce radiation in electrophysiology procedures, lowering exposure for patients and the electrophysiology (EP) team without reported loss of safety or efficacy.

At a glance

Type of study
Narrative review
Who was studied
Electrophysiologists, Mixed lab staff, Patients
Summary based on
the full text

What it found

  • Ultra low-dose fluoroscopy protocols markedly reduce dose in complex ablation without worsening procedure times, outcomes or complications.

    Key figures: 30-fold reduction of dose-area product (DAP)

  • Typical lifetime occupational exposure for cath lab operators carries a meaningful attributable cancer risk.

    Key figures: 50-200 mSv; excess cancer risk 1 in 100

  • Reducing frame rate substantially lowers radiation dose; cine mode delivers roughly 10 times the dose of fluoroscopy.

    Key figures: six- to eight-fold reduction (25 to 3.75 fps); ~10-fold higher in cine

  • Lead mattress reduces scatter; suspended protection systems or cabins reduce exposure to near background and relieve orthopaedic load, while lead gloves offer limited reduction.

    Key figures: up to 70% (mattress); 10-30% (gloves)

  • Radiation awareness was lacking in many centres according to an EHRA survey.

    Key figures: >25% used ≥12 fps; >40% did not or only occasionally used collimation

Limits to keep in mind

Narrative expert review without systematic search; cited dose studies were selected for reduction interventions and may not reflect real-life practice, and most data concern patient dose metrics rather than measured staff dose or health outcomes.

How this summary was made

ORSIF prepared this summary with AI assistance from the full text of the paper. A program then checked that the passage supporting each finding appears word for word in that source. A person has not yet reviewed each summary, so read the original before relying on a number. ORSIF summarizes research and does not endorse any product or company. Report a problem with this summary.

Prepared November 3, 2026.