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

Abstract

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.

Micra™ Leadless Intracardiac Pacemaker Implantation: A Safer Option During the Coronavirus Disease 2019 Pandemic

“…The average total dose-area product during the procedures was 914.4 ± 992.4 Gy • cm. 2 Postprocedure, one patient developed a femoral artery pseudoaneurysm, which was managed with a thrombin injection. One COVID-19 patient experienced in-hospital mortality on the third postoperative day secondary to hypoxic respiratory failure triggered by COVID-19.…”

“…Second, implantation of the Micra™ system is itself a less-invasive procedure, allowing for shorter time to be spent in the electrophysiology lab and a reduced mean fluoroscopy time (2.7 minutes) as compared with a mean fluoroscopy time for single-chamber transvenous pacers of 5.5 minutes. 2 Moreover, due to its smaller size and less-invasive approach, implantation of the Micra™ system was associated with fewer hospitalizations; system revisions; and complications such as pneumothorax, device emboli, dislodgement, and infections relative to traditional transvenous pacemakers at six months of follow-up, with comparable levels of efficacy observed for both. 1 Even though only three patients tested positive for COVID-19 in this series, enhanced droplet and aerosol precautions were maintained for all patients given the unknown false-negative rate of the real-time polymerase chain reaction SARS-CoV-2 RNA test.…”

Pacemaker Implantation without Fluoroscopy and Guided by Anatomical Mapping

“…10 This approach can be considered the first option in pregnant patients in order to avoid fluoroscopy exposure, since the procedure appears safe and with a similar procedural duration, 20 minutes longer than the usual pacemaker implantation, though this would likely decrease with experience. The use of 3D anatomic mapping has proven to significantly reduce fluoroscopy time and fluoroscopy dose during routine device implantation, 11 as well as being a safe and effective approach. 12 Some limitations of this approach should be mentioned.…”

Contactless Electrocatheter Tracing within Human Body via Magnetic Sensing: A Feasibility Study

“…Then, the catheter tip sensor is precisely located using triangulation in space [ 14 ]. Recently, the use of these devices has been preliminarily proposed to drastically reduce radiation dose during pacemaker and defibrillator lead implantation procedure procedures [ 15 , 16 , 17 , 18 , 19 ]. However, these techniques rely on the use of such special catheters, which are specific for electrophysiology and ablation studies.…”