Patient Characteristics and the Incidence of Radiation-induced Dermatitis Following Radiofrequency Catheter Ablation

Abstract

Background and objectives: Radiofrequency catheter ablation (RFCA) exposes patients to fixed angle radiation for extended periods of time. We investigated the incidence and characteristics of radiation-induced dermatitis (RID) associated with RFCA.

Subjects and methods: We screened 1347 consecutive patients from 2000 to 2011 who underwent RFCA for any indication and reviewed patients with dermatologic issues at the 1-month follow-up. Skin lesions were classified into three groups: most likely RID, probable RID, and possible RID.

Results: Of the 1347 enrolled patients, 12 (0.89%) experienced dermatologic issues within 1 month after RFCA, including six patients (0.45%) clinically classified as 'most likely RID' and four patients (0.30%) with 'probable RID'. Ten patients, including most likely RID or probable RID patients, developed skin lesions on the right back and upper arm. Skin lesions did not improve without meticulous treatment, and three cases required surgical intervention. We compared the RID group to the remaining 1335 patients (normal group). The mean body mass indices (BMIs) of the RID and normal groups were 29.3 and 23.9 kg/m², respectively (p<0.001). Radiation exposure times were longer in the RID group (180±31.0 vs. 47±49.9 minutes, p<0.001). We further analyzed 44 patients (6 RID cases and 38 normal patients) that had BMIs >26 kg/m² and exposure times >115 minutes based on receiver operator characteristic curve analyses. Among the 35 patients without RID, 29 patients (82.9%) did not use biplane fluoroscopy.

Conclusions: Patients with high BMIs have a higher risk of developing severe RID with increasing fluoroscopy times using biplane fluoroscopy.

Keywords: Body mass index; Catheter ablation; Dermatitis; Fluoroscopy; Radiation.

Fig. 1. Radiation induced dermatitis. Medical photos of six patients with dermatitis that is most likely RID. RID: radiation-induced dermatitis.

Fig. 2. ROC curve results for predicting RID. The BMI cutoff was 26 kg/m² and fluoroscopy time cutoff value was 115 min. ROC: receiver operator characteristic, RID: radiation-induced dermatitis, BMI: body mass index, AUC: area under curve.

Fig. 3. Recommended radiation projection angle to prevent RID. Distance between the radiation generator and a patient with a low BMI (A) or high BMI (B). The recommended projection angle for patients with a high BMI and long procedural times (C). RID: radiation-induced dermatitis, BMI: body mass index, LAO: left anterior oblique, RAO: right anterior oblique.