Zero X ray approach for the ablation of Supraventricular Tachycardia performed exclusively by wOmen OPerators: The STOOP Multicenter Registry

Abstract Background Amongst EU countries, there is substantial discrepancy on how Euratom Directive is applied: some Countries allow women to work during pregnancy and breastfeeding with a maximum cumulative dose exposure of <1 mSv, others are more restrictive and stop women to work in the Cath Labs, and this contributes to workforce gender disparity. Aim We sought to investigate the 1-year cumulative dose exposure of women electrophysiologists performing zero- or near-zero fluoroscopy catheter ablation procedures and whether this value is inferior to the current maximum allowed limit. Furthermore, we sought to investigate whether the experience of the operator impacts the Dose Area Product (DAP). Methods The STOOP Registry is a multicentric study involving 14 centers across Europe (11 in Italy, 2 in Spain and 1 in Croatia) and including EP procedures performed with a zero or near-zero fluoroscopy approach exclusively by women operators. Consecutive patients referred for all supraventricular tachycardia, with the exception of atrial fibrillation, ablation were considered. For this analysis, only the centers who started the enrollment at least 1 year ago were included. Results Overall, 269 EP procedures performed by 9 women operators from 4 centers were included. The mean age of the operators was 45±10 years, 41% of them declared that they were used to perform <50 zero or near-zero fluoroscopy procedures per year, and 49% of them performed less than 500 catheter ablations during their lifetime. The mean annual DAP per operators was 11.2±25.5 mGy * cm² and the mean annual Effective Dose per operator was 0.002 mSV ± 0.004 mSV. None of the operators reached the maximum cumulative dose limit of 1 mSv. The use of fluoroscopy was necessary in 23 procedures (8,6%): 2 were atrioventricular nodal reentrant tachycardia, 3 were typical/atypical flutter and the remaining cases were accessory pathway ablations. No differences in DAP were found between operators who were used to perform<50 or >50 zero or near-zero fluoroscopy procedures per year. Conclusions The annual cumulative dose exposure of women electrophysiologists performing supraventricular tachycardia ablations, adopting a zero or near-zero X ray approach, is low, and well below the maximum European limit allowed during pregnancy, furthermore the operator’s experience doesn’t impact it. The study is still on going in the centers involved.