Occupational fetal dose during interventional electrophysiology in pregnancy: a prospective trimester-stratified dosimetry study under ALARA principle and 3D electroanatomical mapping
V Buia, D Stangl, J Walascheck, R Saro, D Bastian, H Rittger, L Vitali-SerdozAbstract
Introduction
pregnancy in female interventional electrophysiologists raises concerns about occupational radiation safety. European and international guidelines recommend a maximum additional fetal exposure of 1 mSv for the entire pregnancy, a threshold frequently cited to justify exclusion of pregnant operators from invasive electrophysiology (EP) in many countries. Modern three-dimensional (3D) electroanatomical mapping systems allow for ablation procedures with minimal or no fluoroscopy, potentially permitting continuation of clinical practice during pregnancy. We present the first prospective trimester-stratified dataset of occupational fetal dose monitoring in a pregnant electrophysiologist performing ablations across all trimesters.
Methods
between February and September 2025, thirty-eight ablations were performed from a pregnant electrophysiologist from the first to her third trimester. A continuously active electronic dosimeter was worn at abdominal level to approximate fetal exposure. Procedural data included ablation type, trimester, fluoroscopy use, fluoroscopy time (FT), dose-area product (DAP), and dose differences (Δ-dose) measured at the beginning and at the end of the procedure.
Results
Zero-fluoroscopy was achieved in 76,3% of cases. Procedures included pulmonary vein isolation (n=13), cavotricuspid isthmus ablation (n=10), atrioventricular nodal reentrant tachycardia (n=8), right atrial focal tachycardia (n=3), left atrial tachycardia (n=2), right- (n=1), and left-accessory pathway ablations (n=1). All transseptal punctures were guided by transoesophageal echocardiography, and 46,15 \% were completed entirely without fluoroscopy. Mean FT was 0.08 minutes (+/- 0.388), and mean DAP was 0.207 cGy·cm² (+/- 1.03). Mean Δ-dose at the abdominal dosimeter was 0.205 µSv (+/- 0.41). Cumulative Δ-dose across the pregnancy was 8 µSv, distributed as 2 µSv in the first trimester, 2 µSv in the second, and 4 µSv in the third. No correlation was found between Δ-dose and either FT or DAP (Spearman ρ = −0.10, both p > 0.5). The cumulative dose was comparable to that of a single short-haul European flight.
Conclusions
This study demonstrates that, with rigorous application of ALARA principles, modern 3D electroanatomical mapping, and comprehensive protective measures, complex ablations can be performed by pregnant electrophysiologists with negligible occupational fetal dose. Our findings support the adaptation and optimization of the EP work environment—including workflow, imaging settings, shielding, and mapping-first strategies—so that pregnant operators can safely continue laboratory duties in full compliance with radiation-protection standards for fetal exposure.Fetal radiological exposure doseProcedure table