Flouroscopy Risks during Implant Procedure

My EP has recommended that I get a CRT-D installed, and the more I read about it the more nervous I get about the whole thing.  I was reading about the implant procedure, and it sounds like fluoroscopy is always used when implanting pacemakers, ICDs & CRT-Ds.

From what I am reading, fluoroscopy exposes the patient to a huge amount of radiation that can lead to skin burns or even cancers later in life.  Has anyone discussed this risk with their EPs, and if so, what were you told about it? If it’s a 2-4 hour procedure, that sounds like an enormous amount of radiation you’re exposed to. My EP said that the large amount of radiation exposure was "for the most part, acceptable".  Not very comforting :-(   




by Tracey_E - 2019-01-31 15:59:03

It's the same with any diagnostic procedure that uses radiation- is the knowledge gained worth the potential risk? Usually yes. In our case, the risks of not being paced FAR outweigh any potential issues from the fluoroscopy. 

I've never heard of any side effects from it, and I've never personally experienced it. The full procedure from start to stop is 2-4 hours, the actual amount of time it takes to place a lead is considerably less. I am on my 5th pacer, do a lot of my own research and constantly question my doctor/nurse/technician/reps,  am a long time active member here, and never ONCE heard of burns happening to a patient getting a pacer.

From what my doctors have told me when I ask about radiation, it's not one single test/procedure, it's the cummulative over many years that causes the risk. Doesn't much matter if I get cancer late in life if my heart gives out well before that. If pacing comes with some risks, so be it, because without it I wouldn't be here to have the discussion. But I'll be paced 25 years this spring and have never once had a complication worth mentioning. 

It's good to do your homework and understand what's going on, but you can't believe too much of what you read on the internet and it's easy to start overthinking things. You are getting a CRT-D, which means 3 lead pacing as well as a defibrillator which means your heart problems are not insignificant. The pacing will make you safer and hopefully give you better quality of life. The defib can save your life. That's a lot at stake, to my mind more worrisome than any potential problems from the radiation it takes the place a lead.  


by donr - 2019-01-31 23:31:28

Do you drive?  Do you eat?  Do you drink water?  How about crossing the road?  take a shower or bath?  Every one of those actions has a non-zero probability of causing your death - especialy taking a bath or shower.

I can talk to you about radiation induced cancer & radiation burns - you see, I have one (The burn, that is).  Kinda in an inaccessible spot.  You see, I got thet burn from radiation therapy for prostate cancer back in 2004.  I'm still here, some 14 yrs later at now age 82+.  Since that time, I've had my PM replaced - no fluoroscopy for that, survived a major auto accident, colon cancer remotely located from the Prostate area,   aspirational pneumonia, a heart attack.   Pre Prostate cancer, I survived a PM implant, a lead replacement , a bout of salmonella, three exposures to Rabies,  The Flu epidemic of 1957 (which I caught), and a year in Viet Nam.  Every one of those events could have killed me!  Life is just chock full of dangerous events. 

Tracey said it all very elegantly - & she is totally correct.  But back to radiation:  Let me tell you how much it takes to possibly cause burns & cancer - My radiation was so powerful it took ferrro-concrete walls  over a foot thick to contain it  But it was concentrated on an area the diameter of a large walnut to expose my afflicted parts.  I recieved 5 - 15 second doses each day for 45 days. The doses were at angles to reduce the effect on any single part of the body - except what was to be nuked. That part shriveled up and is now dead.  But I am alive!  14-1/2 years later. 

My radiation oncologist & I talked long and seriously about side effects, etc.  I had a choice between the Rad-therapy & radical surgery.  He convinced me that the safety of the radiation I got and how it was controlled out-weighed the risk.  I am living proof that he was correct.  Now - had  I recieved all that radiation as whole body - I'd have been dead after the first day.  Point being that there are so many variables to the radiation dangers.  You live in Colorado Springs - Elev 6072 ft - Your probability of developing Melanoma is significantly higher than for Tracey, down on the FLA coast at 0 ft Elev. 

Fluoroscopy has changed over the years.  It now is LESS dangerous than when I had my first upper & lower GI series of X-rays in the mid 1900's.  The biggest improvement is in sensitivity of receptors, requiring less radiation.  Ditto for the CAT scanners used today.  The real danger is tothe EP doing the work - he/she is in there every time a PM gets done.   Lesee, now - you get that radiation every 8-10 yrs.  Not a bad trade-off for the improved life you get.

Last Thanksgiving I had an ER Doc ask me if I would have a CTA scan of the chest, looking for micro pulmonary emboli.  He specified the potential risk from the radiation I'd get.  My answer - at my age, I'll die from something else before I can develop the cancer.  But I asked him one question before that answer - Was he running the scan out of idle curiousity - or would he leaqrn something useful?  His answer - I learn something useful - do you have any PE's? That will tell me a lot about how serious your situation is and how to treat you.

Radiation is a mixed blessing and is not necessarily clear cut in evaluating whether to use it or not.  Its use at high levels is truly a judgement call.  F'rinstance - back in the ice age of the 1960's  a colleague of mine was discovered to have testicular cancer at the ripe old age  of 30.  Surgery was a smple decision - the followup radiation was not.  At that time the ability to shape and modulate beams was not developed.  I think the medical device was calledd the "Bevatron".  He elected to take the therapy, even though he rec'd a significant quantity of whole body radiation that made him sick for several months.  Three years later, he was well enough to take a Viet Nam tour. (We were both in Uncle Sam's Army).  He lived long enough to retire from the Army.  He took a job with Boeing Aircraft.  He worked another twenty years and retired from Boeing.  Now, at age 83-1/2 he is still alive and quite healthy..  Radiation is not a positive killer - it is a probabalistic/statistical thing. You cannot apply statistics to an individual; it applies only to groups

Now you do get a significant amount of radiation exposure to vital organs from  the fluoroscope during a PM implant.  But to most of s, the risk is well worth it







Donr - wow!

by LondonAndy - 2019-02-01 07:54:25

Hats off to you - you have been through a lot, and such a positive attitude would help so many people if they could copy it.  I take the same view: if it has to be done then do it. 

Radiation Risk with medical procedures

by Selwyn - 2019-02-01 08:44:44

There is always an increased risk of cell damage with radiation. Exactly what the risk is, is  complicated :

 see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/ 

However, there is normal background radiation,increased risk of radiation such as flying in an aeroplane, going through an airport security scanner that has to be taken into account.  So for a chest X ray, this is equivalent to about 10 days of extra background radiation ( in the UK, some rocks in Cornwall produce radon gas and people are exposed all their lives to a higher than usual level). We did have Chenobyl!

As Donr states, the onset of image intensification, means that radiologists are no longer using fluorescing screens and the radiation used is quite small.  I remember the days when you could go to a shoe shop and have your feet X-rayed to see the fit!

Personally, I have lost count of the number of CT scans I have had ( I am waiting for another in the next month). I have had 3 ablations under X-ray control, a PET scan ( now there is some serious radiation), and two courses of linear accelerator radiation for cancer ( I have a burn to my back).

A pacemaker or ICD fit is life saving. 

People die in bed. Bed rest has got its own mortality. 

Nothing in life is without some risk. 

Best not to worry about about the small things in life or you might worry yourself to death!

worrying about the wrong thing

by dwelch - 2019-02-12 06:02:58


I am sure the machines they used for my first pacer 30 years ago is worse than one ones today, I have zero fear of medical xray machines of any kind.  Contributes next to nothing.  And I live in a brick house, which doesnt bother me either.

The only thing you should be worried about is not getting the pacer/icd and/or how long before you can get one.  The procedure is the procedure for every story about something happening there are countless boring stories not worth mentioning.  like number of plane wreck stories compared to number of successful plane flight stories (compared to number of successful plane flights).  

As pointed out the docs and nurses are the ones that need to be worried about radiation, not the patients.  I guess it is technically possible to do open heart surgery to set the lead but how does that risk compare to doing it the normal way and how hard would it be to find a doc that would do that anyway...

Focus on the risk/reward of having the device or not rather than the procedure.





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