Implantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic mapping system

Abstract

AimsThe aim of this study is to show the feasibility of a biventricular implantable cardioverter-defibrillator [cardiac resynchronization therapy (CRT)–ICD] implantation using an electroanatomic navigation system and a low dose of fluoroscopy. Here four case reports of patients affected by dilated cardiomyopathy, who underwent cardiac resynchronization therapy, are described.Methods and resultsDuring 2010, four patients were admitted to our Cardiology Department for implantation of an CRT–ICD device in primary prevention. All had an ejection fraction of <35% and were in New York Heart Association class III despite optimal medical therapy. The implantations were performed using the EnSite NavX system. All the leads were positioned in the cardiac chambers utilizing the three-dimensional navigation system and only using X-ray to check that the leads had been positioned correctly. To our knowledge, these cases are the first use of an electroanatomic system for implantation of an CRT–ICD device and in all four cases the cannulation of the coronary sinus (CS) was performed only using the mapping system. Electroanatomic navigation made it possible to minimize X-ray exposure during the implantation of the CRT–ICD device; in addition, the mapping system was used to choose the optimum position of the CS catheter using as reference the maximum activation delay between the two ventricles.ConclusionsThe NavX system shows great potential during the implantation of an CRT–ICD device. It seems to be feasible, safe, and extremely beneficial in terms of a reduction in X-ray exposure. Furthermore, there is benefit of more detailed information and accuracy during the CS lead placement.

Three‐Dimensional Electroanatomic Mapping System‐Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry

“…In the setting of device implantations, EAMS have been used to reduce radiation dose particularly in children and pregnant women . Recently, the first experiences of CRT devices implantation guided by EAMS have been published . The preliminary findings of these studies indicated that this approach significantly reduces radiation exposure and may even allow fluoroscopy to be completely avoided .…”

Permanent pacemaker implantation without fluoroscopy in a pregnant woman with complete atrioventricular block: A case report

“…Few case-series exist on using EAM guidance for PPM insertion in general population [4], [6]. To the best of our knowledge this is the third case of dual chamber PPM in a pregnant women using EAM system [3], [7].…”

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

“…Taking advantage of our experience in using the electroanatomic mapping systems for electrophysiology procedures, for the first time in our center we used MS in CRT device implantation for LV lead positioning in order to avoid the infusion of contrast medium in a CKD and ICM-allergic patient. The method described by Del Greco et al 4 for CRT-D implantation guided by electroanatomic MS is reproducible and feasible. The device implantation was completed without complications, with a procedural time comparable to a traditional approach and with a reduced fluoroscopy time 6 .…”