1
|
Tamirisa KP, Oliveros E, Paulraj S, Mares AC, Volgman AS. An Overview of Arrhythmias in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:36-50. [PMID: 38495654 PMCID: PMC10941715 DOI: 10.14797/mdcvj.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease significantly jeopardizes pregnancies in the United States, impacting 1% to 4% of pregnancies annually. Among complications, cardiac arrhythmias are prevalent, posing concerns for maternal and fetal health. The incidence of arrhythmias during pregnancy is rising, partly due to advances in congenital heart surgery and a growing population of women with structural heart disease. While most arrhythmias are benign, the increasing prevalence of more serious arrhythmias warrants a proactive approach. Guidance and reassurance suffice in many cases, but persistent symptoms require cautious use of antiarrhythmic drugs or other therapies for a safe outcome. Managing more serious arrhythmias requires a comprehensive, multidisciplinary approach involving specialists, including maternal-fetal medicine physicians, cardiologists, electrophysiologists, and anesthesiologists.
Collapse
|
2
|
Luke K, Milla C, Tandi JK, Julario R. Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta-analysis. J Arrhythm 2024; 40:38-46. [PMID: 38333407 PMCID: PMC10848632 DOI: 10.1002/joa3.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024] Open
Abstract
Background Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. Method A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non-English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach. Results Seven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33-4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: -0.35 to 0.55 and SMD: -0.71, 95% CI: -1.87-0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: -1.80, 95% CI: -2.49 to -1.12 and SMD: -1.26, 95% CI: -2.24 to -0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41-2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20-0.59). Conclusion ZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.
Collapse
Affiliation(s)
- Kevin Luke
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Clonia Milla
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital‐Universitas AirlanggaSurabayaIndonesia
| |
Collapse
|
3
|
Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
Collapse
Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
| | | |
Collapse
|
4
|
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 827] [Impact Index Per Article: 413.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
5
|
Ge X, Chen M, Sha Z, Zhang J. Three-dimensional mapping in cardiac implantable electronic device - a feasible and effective alternative to fluoroscopy. J Interv Card Electrophysiol 2022; 66:783-792. [PMID: 35809160 DOI: 10.1007/s10840-022-01297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the last decade, three-dimensional mapping technology has substantially aided the development of cardiac implanted electronic devices (CIEDs). This article intends to present an outline of the use and benefits of three-dimensional (3D) mapping systems in CIEDs. RESULT As an alternative to fluoroscopy, 3D mapping greatly minimizes radiation exposure and eliminates the need for contrast dye during the implantation of CIEDs. Based on the visualization of the pacing lead tip and accurate anatomic reconstruction of the chamber of interest and a specialized mapping technique, 3D mapping technology dramatically improves the efficacy and success of the advanced cardiac implantable devices' placement. Additionally, it provides a superior option for those with complex medical conditions. CONCLUSION The use of 3D mapping technology in CIEDs has been proven feasible and effective by accumulating evidence. It is fair to anticipate that it will be widely used in CIED implantation in the future.
Collapse
Affiliation(s)
- Xiaozhen Ge
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Mengna Chen
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Zhongxin Sha
- Department of Cardiology, Guiyang First People's Hospital, Guizhou, China
| | - Junmeng Zhang
- Department of Cardiology, First Affiliated Hospital of Tsinghua University, Beijing, China.
| |
Collapse
|
6
|
Kristensen J, Kronborg MB, Gerdes C, Nielsen JC. Electroanatomical mapping- and CT scan image integration-guided pacing lead implantation: A case series and review of the recent literature. Heart Rhythm O2 2021; 1:341-350. [PMID: 34113892 PMCID: PMC8183844 DOI: 10.1016/j.hroo.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background We present a case series and short review of electroanatomical mapping (EAM)–guided pacing lead implantation. The cases illustrate different aspects of EAM use in special circumstances and summarizes our experience with EAM-guided His lead implantation in 32 consecutive patients. Advantages and caveats encountered when using EAM in device procedures are discussed. Objective To illustrate usefulness of EAM-guided lead implantation and computed tomography (CT) image integration in a case series. Methods Lead implantation was performed targeting different anatomically defined regions using EAM for mapping and lead navigation, as well as using the system for image integration for 2 cardiac resynchronization therapy implantations. Results For His bundle pacing lead implantation, a steep learning curve for successful His bundle lead placement seems obtainable (91%) for new implanters using EAM-guided implantation. Successful lead placements in other locations guided by anatomical or physiologically defined positions are demonstrated in individual cases. However, map shifts are frequently encountered and should be recognized and corrected. Conclusion EAM-guided His bundle lead implantation seems to be a useful tool for arriving at high success rates for new His lead implanters with a steep learning curve, if appropriate precautions are undertaken. In selected cases EAM and CT scan image integration can be of benefit in lead implantation in other locations. Knowledge of specific problems in using EAM for device procedures should be recognized.
Collapse
Affiliation(s)
- Jens Kristensen
- Department of Cardiology, Section for Arrhythmia, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Section for Arrhythmia, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Christian Gerdes
- Department of Cardiology, Section for Arrhythmia, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Section for Arrhythmia, Aarhus University Hospital Skejby, Aarhus, Denmark
| |
Collapse
|
7
|
Whitaker J, Kreidieh O, Singh M, Barge J, Koplan B, Kapur S. Radiation-free nonselective His pacing lead implantation in a pregnant patient with congenitally corrected transposition of the great arteries. HeartRhythm Case Rep 2021; 7:323-327. [PMID: 34026525 PMCID: PMC8134773 DOI: 10.1016/j.hrcr.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- John Whitaker
- Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Omar Kreidieh
- Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michal Singh
- Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | | | - Bruce Koplan
- Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sunil Kapur
- Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Address reprint requests and correspondence: Dr Sunil Kapur, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115.
| |
Collapse
|
8
|
Israel CW, Richter S, Bukachi F. [Bradycardia in pregnancy : Case report and review of the literature]. Herzschrittmacherther Elektrophysiol 2021; 32:221-226. [PMID: 33956224 DOI: 10.1007/s00399-021-00773-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
We report the case of a pregnant woman with complete heart block during her first trimester who presented with dyspnea at the East African Heart Rhythm Project in Nairobi. There was no evidence of an acute cause (e.g., myocarditis, cardiomyopathy, autoimmune or neuromuscular disease). No ECG had been previously documented; therefore, congenital complete heart block was likely. We implanted a dual-chamber pacemaker using conventional fluoroscopy. Several measures at implantation allowed us to limit fluoroscopy to 30 s and radiation to < 100 µGym2. The implantation was uneventful, dyspnea improved instantaneously and further pregnancy, labor and birth were uncomplicated. Bradycardia requiring pacemaker implantation is rare during pregnancy and usually consists of symptomatic complete heart block. Beyond undiagnosed or untreated pre-existing atrioventricular block, drug therapy for fetal tachycardia, myocarditis (including Lyme borreliosis and Chagas disease), inflammatory infiltrative diseases (e.g., sarcoidosis), cardiomyopathies and neuromuscular disease may have caused bradycardia. In the absence of treatable causes, pacemaker implantation becomes necessary if bradycardia brings about risks for the mother or the fetus. Using transesophageal or intracardiac echocardiography, radiation can be avoided completely or, by taking some simple measures, may be kept to a minimum so that there is no risk for the fetus.
Collapse
Affiliation(s)
- Carsten W Israel
- Evangelisches Klinikum Bethel, Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Universitätsklinik Ostwestfalen-Lippe, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Sergio Richter
- Klinik für Innere Medizin/Kardiologie, Abt. Rhythmologie, Herzzentrum und Universität Leipzig, Leipzig, Deutschland
| | | |
Collapse
|
9
|
Chaudhry-Waterman N, Kumar V, Karr S, Fitzpatrick A, Cohen MI. Challenge of managing opposing rhythms in a mother and fetus. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:373-377. [PMID: 32896920 DOI: 10.1111/pace.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We report a case of a fetus with complex congenital heart disease and supraventricular tachycardia in the setting of maternal high grade atrioventricular block at 26 weeks' gestation. METHODS AND RESULTS Electroanatomic mapping allowed successful implantation of a permanent pacemaker to provide adequate back-up pacing in the mother with zero radiation exposure, thus allowing safe delivery of transplacental anti-arrhythmic medications to reduce the fetal arrhythmia burden and optimize the fetal ventricular rate. CONCLUSION This is the first reported case of using electroanatomic mapping, with zero fluoroscopy use, for pacemaker lead placement and for a novel indication.
Collapse
Affiliation(s)
| | - Vineet Kumar
- Department of Cardiology, INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Sharon Karr
- Pediatric Cardiology Associates/Mednax, St. Jude Medical, Austin, Texas
| | - Andrew Fitzpatrick
- Department of Pediatric Cardiology, INOVA Children's Hospital, Falls Church, Virginia
| | - Mitchell I Cohen
- Department of Pediatric Cardiology, INOVA Children's Hospital, Falls Church, Virginia
| |
Collapse
|
10
|
Qiu J, Wang Y, Chen G, Zhao C, Wang DW. Progress in zero-fluoroscopy implantation of cardiac electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:609-617. [PMID: 32348595 DOI: 10.1111/pace.13930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
11
|
Larsen TR, Saini A, Moore J, Huizar JF, Tan AY, Ellenbogen KA, Kaszala K. Fluoroscopy reduction during device implantation by using three-dimensional navigation. A single-center experience. J Cardiovasc Electrophysiol 2019; 30:2027-2033. [PMID: 31392815 DOI: 10.1111/jce.14102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/21/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
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.
Collapse
Affiliation(s)
- Timothy R Larsen
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Aditya Saini
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica Moore
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jose F Huizar
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| |
Collapse
|
12
|
Assessment of a novel radiation reduction protocol for pediatric and adult congenital device implantation. J Interv Card Electrophysiol 2018; 55:93-98. [PMID: 30413993 DOI: 10.1007/s10840-018-0479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Device implantation requires fluoroscopic guidance, which carries inherent risks of ionizing radiation. We evaluated the impact of a low-dose fluoroscopic protocol on radiation exposure during device implantation. METHODS All patients who underwent pacemaker or ICD implantation with new transvenous leads from July 2011 to January 2018 were included. A novel ALARA protocol consisting of ultra-low frame rates (2-3 frames/s), low dose/frame (6-18 mGy/frame), and use of the "air-gap" technique in patients < 20 kg was employed. Demographics, procedural data, and radiation exposure levels were collected and analyzed. RESULTS Thirty patients underwent device implantation without additional catheterization, electrophysiology study, or ablation procedure (median age 15 years; range 5-50) with a total of 43 leads placed. Forty-seven percent of patients had a primary rhythm disturbance, 33% had cardiomyopathy, and 20% had congenital heart disease. Fifty percent were pacemakers (53% dual-chamber, 27% ventricle, 20% atrial) and 50% of devices implanted were ICDs (87% single-chamber). All implants were acutely successful with acceptable atrial and ventricular sensing and capture thresholds. The median fluoroscopy time was 11.5 min (inter-quartile range (IQR) 8.0-18.2), median air kerma dose 4.0 mGy (IQR 2.5-19.5), and median dose-area product 27.8 μGy/m2 (IQR 17.1-106.5). Median implant procedure time was 133 min. One patient required revision secondary to device migration without lead derangement 2 days post-procedure. CONCLUSIONS Use of a novel fluoroscopic protocol may help decrease radiation exposure to patients and staff without affecting efficacy or risk. These data may represent benchmarks against which future device implantation procedures can be compared.
Collapse
|
13
|
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1121] [Impact Index Per Article: 186.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
14
|
Silvetti MS, Battipaglia I, Pazzano V, Saputo FA, Ravà L, Ammirati A, Calvieri C, Ciani M, Drago F. Electroanatomic mapping-guided localization of alternative right ventricular septal pacing sites in children. Pacing Clin Electrophysiol 2018; 41:1204-1211. [DOI: 10.1111/pace.13447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/30/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Fabio Anselmo Saputo
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Lucilla Ravà
- Epidemiology Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Antonio Ammirati
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - Camilla Calvieri
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | | | - Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| |
Collapse
|