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

Greco, Maurizio Del; Maines, Massimiliano; Marini, Massimiliano; Colella, Andrea; Zecchin, Massimo; Vitali-Serdoz, Laura; Blandino, Alessandro; Barbonaglia, Lorella; Allocca, Giuseppe; Mureddu, Roberto; Marenna, B.; Rossi, Paolo; Vaccari, Diego; Chianca, Roberto; Indiani, Stefano; Matteo, Irene Di; Angheben, Carlo; Zorzi, Alessandro

doi:10.1111/jce.13120

Cited by 30 publications

(38 citation statements)

References 36 publications

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“…Several studies utilized three‐dimensional mapping systems for CIED implantation. In those studies, no acute or long‐term adverse effects on the pulse generator were described …”

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Dinshaw¹,

Schäffer²,

Akbulak³

et al. 2019

Cardiovasc electrophysiol

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Introduction Long‐term efficacy and safety are uncertain in patients with cardiac implantable electronic devices (CIED) and transvenous leads (TVL) undergoing radiofrequency catheter ablation of atrial fibrillation (AF). Thus, we assessed the outcome of AF ablation in those patients during long‐term follow‐up using continuous atrial rhythm monitoring (CARM). Methods and Results A total of 190 patients (71.3 ± 10.7 years; 108 (56.8% men) were included in this study. At index procedure 81 (42.6%) patients presented with paroxysmal AF and 109 (57.4%) with persistent AF. The ablation strategy included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines, if appropriate. AF recurrences were assessed by CARM‐ and CIED‐related complications by device follow‐up. After a mean follow‐up of 55.4 ± 38.1 months, freedom of AF was found in 86 (61.4%) and clinical success defined as an AF burden less than or equal to 1% in 101 (72.1%) patients. Freedom of AF was reported in 74.6% and 51.9% (P = 0.006) and clinical success in 89.8% and 59.3% (P < 0.001) of patients with paroxysmal and persistent AF, respectively. In 3 of 408 (0.7%) ablation procedures, a TVL malfunction occurred within 90 days after catheter ablation. During long‐term follow‐up 9 (4.7%) patients showed lead dislodgement, 2 (1.1%) lead fracture, and 2 (1.1%) lead insulation defect not related to the ablation procedure. Conclusion Our findings using CARM demonstrate long‐term efficacy and safety of radiofrequency catheter ablation of AF in patients with CIED and TVL.

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“…Several studies utilized three‐dimensional mapping systems for CIED implantation. In those studies, no acute or long‐term adverse effects on the pulse generator were described …”

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Dinshaw¹,

Schäffer²,

Akbulak³

et al. 2019

Cardiovasc electrophysiol

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“…10,13 When more than one potential target vessel is available, coronary vein location, length, caliber, and tortuosity may influence the implanting physician's assessment of which coronary vein is to be targeted and which LV lead will be selected. It is often easier to place a guidewire in a prospective target vein than to insert a permanent pacing lead.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 However, the site of longest QLV is variable, and is not always located in the proximal lateral wall. 10,11 Identifying sites of prolonged QLV at implant allows for the selection of sites likely to be associated with a high response rate. Studies that have prospectively measured QLV have thus far used 3D mapping systems or have moved the permanent LV pacing lead from site to site.…”

Section: Discussionmentioning

confidence: 99%

Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation

Rials¹,

Pershing²,

Collins³

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRTtechniques target the posterolateral wall of the left ventricle (LV) using a combination of radiographic appearance, pacing parameters, lead stability, and an absence of diaphragmatic stimulation to determine the final lead position. Unfortunately, CRT is associated with a nonresponder rate of 20% to 40%, depending on the definition used for response. One predictor of response to CRT is the timing of activation measured at the LV electrode relative to the onset of the QRS complex (QLV). Prolonged QLV (QLV > 95 ms) is associated with both an improved acute response to and marked long-term improvement with CRT. 3,4 Prospective measurement of QLV has been described

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“…Harmful effects of radiation, both for the patient and staff, are well established and current guidelines emphasize the importance of reducing radiation dose to “as low as reasonably achievable”. While radiation exposure may be significantly curtailed during electrophysiology studies especially with the use of three‐dimensional electroanatomic mapping (3DM) systems, radiation exposure remains clinically significant during contemporary routine device implantations due to positioning, less distance of the operators from the source, and suboptimal physical barriers . There has been a growing interest to identify innovative ways to minimize radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopy reduction during device implantation by using three‐dimensional navigation. A single‐center experience

Larsen

Saini

Moore

et al. 2019

Cardiovasc electrophysiol

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Background and objectives The use of nonfluoroscopic three‐dimensional electroanatomic mapping (3DM) systems reduces radiation exposure during ablation procedures. In this study, we sought to determine the value of 3DM during routine device implant procedures. Methods Seventy nonselected patients underwent implantation of a single chamber, dual chamber, or biventricular device guided by Ensite (Abbott Laboratories) to limit fluoroscopy use and compared with 70 consecutive patients, who underwent matching procedures with standard fluoroscopy use (FL) in the period immediately preceding the use of 3DM. The venous anatomy, right atrium, and ventricle and coronary sinus were mapped with 0.035 inch J‐wire, quadripolar catheter, and/or angioplasty wire. The leads were advanced under real‐time visualization in Ensite. Results 3DM reduced both fluoroscopy time and dose. Median fluoroscopy time for FL vs 3DM was 5.5 minutes (interquartile range [IQR]: 3.8‐8.1) vs 0.9 minutes (IQR: 0.6‐1.9) (P < .001) for single chamber devices, 6.3 minutes (IQR: 5.1‐7.9) vs 3.3 minutes (IQR: 1.9‐4) (P < .001) for dual‐chamber devices, and 28.6 minutes (IQR: 19.6‐36.2) to 14.7 minutes (IQR: 10.4‐22.3) (P = .009) for biventricular devices, respectively. The median air kerma for FL vs 3DM was 15.4 mGy (IQR: 8.1‐30.2) vs 4 mGy (IQR: 1.8‐8) (P < .001) for single chamber devices, 16 mGy (IQR: 12‐18.5) to 9.4 mGy (IQR: 7.5‐11.3) (P = .001) for dual‐chamber devices, and 324 mGy (IQR: 143‐668.7) to 115 mGy (IQR:77‐204) (P = .014) for biventricular devices, respectively. There were no procedural complications. At 3‐month follow‐up, there was no difference in voltage threshold measurements between the groups. Conclusion The use of 3DM leads to significantly reduced fluoroscopy time and fluoroscopy dose during routine device implantation.

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

Abstract: EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%.

Cited by 30 publications

References 36 publications

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation

Fluoroscopy reduction during device implantation by using three‐dimensional navigation. A single‐center experience

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