LAUSR

Aegrescit medendo, the remedy is worse than a disease, was first described in book XII of the Aeneid [1]. Fluoroscopy has been a necessary evil for the interventional electrophysiologist. The use of lead aprons to mitigate rare fatal cancers has created an epidemic of orthopedic disability. The rapid ascent and technological progress in the field of electrophysiology have resulted in increased diagnostic precision, improved procedural success rates, and improved patient survival. Electrophysiology (EP) researchers and industry must align in their efforts to harness that innovation and prioritize the health of ourselves and our staff, while maintaining safe and effective patient procedures. We provide a review of interventional cardiology radiation/fluoroscopy exposure and then a step-wise approach to completely eliminate fluoroscopy during electrophysiologic ablation (EPA) procedures and the implantation of new cardiac rhythm management (CRM) devices. Fluoroscopy is a continuous live x-ray imaging technique utilizing ionizing radiation that passes through the patient to visualize internal body structures. Following the first transvenous method to implant pacing devices in 1963, fluoroscopy had been the primary cardiac imaging tool to complete these procedures [2]. Two categories of risk reduction are described for the emitted radiation during fluoroscopy. These include methods to decrease either detrimental stochastic effects (DSE, future cancers) or detrimental deterministic effects (DDE, immediate dose-dependent cellular damage) to the patient or lab personnel [3]. One of these risk-mitigating strategies is that all laboratory personnel must wear heavy lead aprons. The consequential orthopedic injury risk from the continued use of lead garments is brought to light. We categorize this risk as detrimental orthopedic effects (DOE). The donning of lead aprons during these daily and long procedures has resulted in the rapidly progressing prevalence of severe musculoskeletal disorders among electrophysiologists. Because DOE has a much greater prevalence and hazard to EP physicians and staff (Fig. 1), DOE is prioritized and appropriately placed alongside DSE and DDE. Major advances in arrhythmia mapping technology by both electroanatomic mapping (EAM) and intracardiac echo (ICE) have provided the ability to eliminate fluoroscopy completely in all forms of cardiac ablation [4–8]. We call upon the EP communities, societies, training programs, and industry to reach freedom from dependency upon fluoroscopy by 2030. The ultimate aim is to eliminate fluoroscopic ionizing radiation use during ablation and implant procedures, eliminate all radiation risks to patients and staff, and thereby eliminate secondary occupational DOE risks of wearing the protective heavy lead aprons each day.