Implantation of a dual-chamber permanent pacemaker in a pregnant patient guided by intracardiac echocardiography and electroanatomic mapping

Electroanatomic Mapping and Intracardiac Echocardiography-Guided Approach for Left-Bundle Branch Area Pacing With Zero Fluoroscopy

“…Intracardiac echocardiography has already been used in conventional pacemaker implantation. 5 This case is the first to describe its use to visualize correct sheath orientation in the interventricular septum. In conclusion, we have shown the feasibility of the zero-fluoroscopy approach.…”

Challenge of managing opposing rhythms in a mother and fetus

“…Unfortunately, fluoroscopy, the imaging modality primarily used in cardiac device placements, is contraindicated in pregnancy 6 . The radiation exposure to the fetus increases the lifetime risk of malignancy, genetic defects, neurological issues, and congenital malformations.…”

“…In order to avoid radiation exposure, we used electroanatomic mapping to guide pacemaker lead placement. This technology is most commonly used to guide electrophysiology catheters during cardiac ablations, 8,9 but has recently been used in very rare cases of device placement, 5 including some in pregnant females 5,6,10,11 . By connecting the pacing wire to the ENSITE system one has the ability to manipulate the pacing wire to the chamber and location of interest.…”

Progress in zero‐fluoroscopy implantation of cardiac electronic device

“…Early in 2008, operators successfully implanted leads in the His bundle and right ventricular apex in canine models with the guidance of the ICE, which indicated a potential role of ICE on zero‐fluoroscopy implantation 11 . However, only one case has currently been reported about the ICE‐guided pacemaker implantation in human, which was published by Chua et al in 2017 12 . In this report, a dual‐chamber pacemaker implantation was performed predominantly using ICE and electroanatomic mapping in a pregnant patient, who was suffered with complete AVB after myocarditis, and all device parameters remained stable during follow‐up.…”

“…As the latest generation of the Ensite series, the Ensite Precision system has a greatly enhanced intelligence and efficiency on the basis of the EnSite Velocity system. It offers new functions, such as the EnSite AutoMap Module for helping to correlate the source of the electrical signals with the physical anatomy of the heart, and TurboMap capability for quickly creating a map of the heart from recorded data 12 . Additionally, the new function of magnetic correction further improves the accuracy and stability of the electroanatomical model.…”