Background  Radiation exposure to patient and surgeon during cardiac implantable electrical device (CIED) procedures remains a substantial health hazard to date. Advanced technical options for radiation dose reduction often pose considerable financial hurdles. We propose a near zero cost, low effort modification to a clinical x-ray system significantly reducing radiation dose during CIED implantation.

Objective        We aim to evaluate a reduced frame-rate protocol in CIED implantation for complication rates and reduction in radiation exposure.

Methods        Starting May 2019 the frame-rate during CIED implantations at our hospital was halved from 7.5 frames/second to 3.8 frames/second, no further technical changes were made. During the following year 264 patients were operated using this protocol and retrospectively compared to 231 cases implanted in the year before the protocol change, totaling 495 cases. Of these, 17%, 63% and 19% were single-chamber, dual-chamber or resynchronization devices, respectively. Incidence of complication prior to hospital discharge was considered primary endpoint of the analysis. Radiation dose and procedural parameters were secondary endpoints.

Results           There was no increase in complications with reduced frame-rate protocol. Regression analysis further supported that reduced frame-rate radiation protocol was not associated with complication rates. Radiation exposure measured as dose area product was significantly reduced by ~62% (median 369 cGy x cm² [IQR 154 – 1207] via reduced frame-rate protocol vs median 970 cGy x cm² [IQR: 400 – 1906] with standard frame-rate (P <0.01).

Conclusion    A reduction of frame-rate during CIED implantation is safe in terms of complication incidence and effective in terms of reducing radiation exposure.