Cardiac resynchronization therapy device implantation guided by electroanatomic mapping system when contrast medium infusion is contraindicated

Cardiac resynchronization therapy-defibrillator implantation guided by electroanatomic mapping in a young adult patient with congenital heart disease

“…Standard implantation technique is guided by angiography with contrast medium infusion, choosing the best site for the LV catheter according to fluoroscopic anatomy of the CS. The new non-angiographic technique by using EAM may be slower than conventional approach during first procedures but allows electrophysiologists to choose not only the best anatomic position but also the best electrical site, to reach the highest electrical resynchronization from the LV pacing [ [2] , [3] , [4] , [5] ].…”

“…The ventricular relationship (consequently, the CS location) and the atrioventricular relationship are normal in D-TGA, so EAM was not used to overcome specific anatomic issues in this case. Even if our patient did not have an unusual CS anatomy or complex atrial anatomy, ACHD patients with systemic left ventricle are known to fare better than other types of congenital patients and they might benefit from this approach not only to obtain an higher response from CRT but also to reduce radiation exposure and to avoid contrast-induced kidney injury [ [2] , [3] , [4] , [5] ]: ACHD patients have often impaired renal function (up to 30–50% of patients [ 8 ]) and undergo several radiologic examinations and cardiac catheterizations using contrast media over the course of their life.…”

“…Cardiac resynchronization therapy-defibrillator (CRT-D) implantation has become an established therapeutic option for adult patients with CHD, symptomatic HF with reduced ejection fraction (HFrEF) and bundle branch block. Several studies have investigated feasibility of a new device implantation technique guided by electroanatomic mapping (EAM) [ [2] , [3] , [4] , [5] ]. EAM enables exploration of the coronary sinus (CS) and its collateral branches, detecting local activation time and electrical delay from QRS onset, in order to find the best position for the left ventricular (LV) lead and to increase the probability of high response from resynchronization, avoiding contrast medium injection and reducing total fluoroscopy time [ [2] , [3] , [4] , [5] ].…”

“…Several studies have investigated feasibility of a new device implantation technique guided by electroanatomic mapping (EAM) [ [2] , [3] , [4] , [5] ]. EAM enables exploration of the coronary sinus (CS) and its collateral branches, detecting local activation time and electrical delay from QRS onset, in order to find the best position for the left ventricular (LV) lead and to increase the probability of high response from resynchronization, avoiding contrast medium injection and reducing total fluoroscopy time [ [2] , [3] , [4] , [5] ]. To the best of the authors’ knowledge, this approach has not been previously described in the ACHD population.…”