Voltage mapping to guide pacemaker placement in patients with CHD

Abstract

Transvenous pacemaker implantation for sinus node dysfunction in patients with Fontan palliation presents the difficulty of finding suitable pacing tissue and the potential of causing vascular obstruction in a low-flow circuit. We describe a patient who underwent electro-anatomic voltage mapping to guide a transvenous single chamber lead within her Fontan baffle. This highlights the use of advanced mapping technologies for pacemaker implantation in complex cyanotic heart disease.

Use of an electroanatomic mapping system with high-density multipolar mapping catheters to guide transvenous atrial pacing lead implantation in a Fontan patient

“… 7 Prior reports have demonstrated the utility of an EAM to identify areas of the highest voltage in patients with congenital heart disease. 8 , 9 Here, in conjunction with a multipolar mapping catheter, we were able to use an EAM to quickly and precisely target a small portion of the highly diseased atrium in which pacing was likely to be successful. This resulted in good sensing and threshold measurements, which have persisted into short-term follow-up.…”

“…They can enable the identification of viable pacing sites and guide lead placement without fluoroscopy in patients with complex congenital heart disease. 8 , 9 Technological advancements of these systems, including the integration of high-density multipolar array mapping catheters, stand to further improve the utility of these systems in guiding lead implantation, particularly in patients without structurally normal hearts.…”

Electroanatomic mapping in atrioventricular junction ablation and pacemaker implantation for permanent atrial fibrillation associated with persistent left superior vena cava

“…Voltage mapping with the EAM system may guide optimal lead placement and has been described in a patient with complex congenital heart disease. 12 …”

“…Voltage mapping with the EAM system may guide optimal lead placement and has been described in a patient with complex congenital heart disease. 12 PLSVC may lead to massive distortion of the Triangle of Koch. In the presented case report, the His bundle electrograms were localized to the superior segment of the right AV junction.…”