Zero‐fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique?

Guo, Ping; Qiu, Jie; Wang, Yan; Chen, Guangzhi; Proietti, Riccardo; Fadhle, Alselmi; Zhao, Chunxia; Wang, Dao Wen

doi:10.1111/pace.13248

Cited by 18 publications

(24 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a portable imaging modality, echocardiography could also be employed to facilitate temporary and permanent pacemaker implantation in intensive care units and reduce in‐hospital transfer 4,6 . Furthermore, the use of non‐fluoroscopic lead implantation for temporary pacemakers has been reported using ultrasound, computed tomography (CT), and echocardiography 4–7 . Subcostal echocardiograph views have been utilized in the acute, perioperative setting to guide insertion of a RV temporary transvenous pacemaker 13 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Sogade

Aben

Eyituoyo

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE). There is also increasing interest in use of non‐fluoroscopic options for noninvasive cardiac electrophysiologic procedures. Methods Fifteen patients consecutively consented for initial implant of CIEDs, specifically dual chamber pacemakers (DCPM) and dual chamber implantable cardioverter defibrillators (DCICDs). Patients were excluded if they had previous implants, abandoned leads, or anatomic anomalies including congenital and known persistent left superior vena cava (PLSVC). We used TTE to guide and implant atrial and ventricular leads. Results Eleven patients received DCPMs and four patients received DCICDs. The procedure duration was 49.3 min for DCICD and 52.3 min for DCPM, p = .807. The average number of right atrial lead attempts was 1.6 for DCPMs and 1.8 for DCICD, p = .860. The average number of right ventricular lead attempts for DCPMs was 2.2 and 1.0 attempt for DCICDs, p = .044. There were no complications at 90‐day follow‐up. Conclusion We demonstrate the feasibility of TTE‐guided DCPM/DCICD implantation without use of fluoroscopy. We present this method as a safe alternative for permanent CIED placement that may reduce risk of radiation exposure and cost while maintaining safety and efficacy. No operators wore lead aprons during the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the use of fluoroscopy is a limiting factor to widespread implantation of CIED in resource‐limited settings. Prior studies have explored non‐fluoroscopic alternatives for temporary device insertion, including electromagnetic mapping systems, ultrasound, and echocardiography in device implantation 4–7 …”

Section: Introductionmentioning

confidence: 99%

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Sogade

Aben

Eyituoyo

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…No complications were observed in all patients, and all pacemakers were functioning properly after 3 months of follow‐up. In our pilot study, 25 we also accomplished zero‐fluoroscopy implantation of single‐ or dual‐chamber pacemaker in six patients with EnSite NavX system, who were in an extremely emergent situation or special populations (pregnant women). Total implantation procedure time of the single chamber pacemaker was 51.3 ± 13.1 min (42.6 ± 7.4 min in the fluoroscopy group; P = .155) and of the dual chamber pacemaker was 88.3 ± 19.6 min (67.3 ± 7.6 min in the fluoroscopy group; P = .013).…”

Section: Ensite Systemmentioning

confidence: 99%

Progress in zero‐fluoroscopy implantation of cardiac electronic device

Qiu

Wang

Chen

et al. 2020

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

Fluoroscopy is the imaging modality routinely used for cardiac device implantation. Due to the rising concern regarding the harmful effects of radiation exposure to both the patients and operation staffs, many efforts have been made to develop alternative techniques to achieve zero‐fluoroscopy implantation. In this review, we describe the different methods aimed at avoiding the application of fluoroscopy in recent years, and evaluate their feasibility and safety in cardiac electronic device implantation.

show abstract

“…Most Electrophysiology laboratory staff is familiar with these systems, they are widely available and frequently used during ablation procedures. Previous case reports have described mapping guided pacemaker and implantable cardioverter‐defibrillator implantations using minimal fluoroscopy technique specifically in pregnant women, pediatric population, and patients with congenital heart diseases but most studies are limited by small sample size and retrospective design. There has been a growing interest in no‐fluoroscopy device implantations with emerging data on safety and feasibility of electroanatomic mapping guided coronary sinus (CS) lead implantation .…”

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

View full text Add to dashboard Cite

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.

show abstract

Zero‐fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique?

Abstract: Ensite NavX system can be used as a reliable and safe zero-fluoroscopy approach for the implantation of single- or dual-chamber permanent pacemakers in specific patients, such as pregnant women or in extreme situations when the x-ray machine is not available.

Cited by 18 publications

References 27 publications

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Progress in zero‐fluoroscopy implantation of cardiac electronic device

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

Contact Info

Product

Resources

About