Cardiac Rhythm Management
Articles Articles 2020 March 2020 - Volume 11 Issue 3


DOI: 10.19102/icrm.2020.110302


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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.


Dear Readers,

The application of ionizing radiation during interventional cardiac procedures is detrimental to both patients and operators alike. A report in 2006 found that radiation exposure among patients had more than doubled since the 1980s,1 with even higher levels likely reached since then. In the literature, the evidence supports a clear association between radiation exposure and cancer.2 Among patients receiving a 100-mSv effective dose, approximately one in 200 will exhibit a fatal cancer and one in 100 will experience a cancer that may or may not be fatal.3 In addition to the potential impact of radiation on the patient, there is a significant risk of adverse effects faced by the operator, with research reporting an association between professional radiation exposure and the risk of developing left-sided brain cancer.4

In the past five years, the trend of using zero or near-zero fluoroscopy during cardiac procedures has gained traction. In particular, advances in technology such as intracardiac echocardiography, advanced three-dimensional electroanatomical systems, and novel transseptal access tools have supported the growth of this trend. This issue of The Journal of Innovations in Cardiac Rhythm Management contains a comprehensive review of the state of fluoroless procedures in cardiac electrophysiology practice.5 The authors summarize the key available studies investigating the adoption of zero or near-zero fluoroscopy and, more importantly, provide detailed step-by-step descriptions of how to perform complex procedures without the use of radiation. I hope that you enjoy reading the article and the remaining content of this issue.

I also would like to take this opportunity to thank the editorial team, section editors, and reviewers of The Journal of Innovations in Cardiac Rhythm Management for the roles they played leading up to the recent achievement of PubMed indexing for the journal. This is an important step in the journey of this young journal and would not have been possible without their hard work, dedication, and expertise. Thank you as well to the readers for your continued support.



Moussa Mansour, MD, FHRS, FACC

Editor in Chief

The Journal of Innovations in Cardiac Rhythm Management

Director, Atrial Fibrillation Program

Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology

Massachusetts General Hospital

Boston, MA 02114


  1. National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. National Council on Radiation Protection report no. 160. Bethesda, MD: National Council on Radiation Protection and Measurements; 2009.
  2. Grant EJ, Brenner A, Sugiyama H, et al. Solid cancer incidence among the Life Span Study of atomic bomb survivors: 1958–2009. Radiat Res. 2017;187(5):513–537. [CrossRef] [PubMed]
  3. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: The National Academies Press; 2006.
  4. Reeves RR, Ang L, Bahadorani J, et al. Invasive cardiologists are exposed to greater left sided cranial radiation: The BRAIN Study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures). JACC Cardiovasc Interv. 2015;8(9):1197–1206. [CrossRef] [PubMed]
  5. Canpolat U, Faggioni M, Della Rocca DG, et al. State of fluoroless procedures in cardiac electrophysiology practice. J Innov Cardiac Rhythm Manage. 2020;11(3):4018–4029. [CrossRef]