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Wang P, Wei GS, Wang JH, Cao YJ, Zhu WW, Shen H, Zhang ZY, Ai L, Wang M. EnSite NavX mapping system guided implantation of a dual-chamber permanent pacemaker in a 41-year-old pregnant woman with a 4-year follow-up. BMC Cardiovasc Disord 2022; 22:325. [PMID: 35864443 PMCID: PMC9306168 DOI: 10.1186/s12872-022-02764-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background X-ray fluoroscopy has been the primary cardiac imaging modality in permanent pacemaker implantation (PPI) operations, but it inevitably results in radiation exposure for both operators and patients. Fluoroscopy is considered a contraindication, especially in certain circumstances, such as gestation, during which the fetus is most sensitive to radiation exposure. Therefore, measures to avoid radiation exposure are necessary, and a more safe and feasible approach is needed for this procedure. Since the EnSite NavX mapping system (ENMS) can create the required geometric contours of those relevant cardiac structures and chambers, it can be used as an alternative to X-ray fluoroscopy in PPI. In addition, because the displacement of atrial leads is a common complication of PPI, lead displacement may occur more readily without fluoroscopic guidance. Therefore, reliable measures are required to prevent leads from displacement. Case introduction A 41-year-old woman at the 15th week of gestation was referred to our department with recurrent episodes of syncope and amaurosis fugax for 2 years. Holter monitoring showed sinus rhythm, Mobitz Type II atrioventricular block and high-grade atrioventricular block with ventricular arrest up to 4945 ms. A dual-chamber PPI was performed successfully for the patient under the guidance of the ENMS instead of fluoroscopy. Displacement of atrial lead was effectively avoided by bending the top of atrial lead before implantation and making it a U-shape during operation, which left space for possible subsequent external pulling stress. Conclusions For PPI, ENMS is a feasible and reliable alternative to traditional X-ray fluoroscopy, especially when performing operations on pregnant patients. By bending the top of the active-fixation atrial lead into a U-shape during operation, the displacement of atrial lead may be avoided.
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Affiliation(s)
- Peng Wang
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China.,Graduate School of Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Guang-Sheng Wei
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China
| | - Jun-Hua Wang
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China
| | - Yan-Jie Cao
- Department of Internal Medicine Teaching Research, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China.
| | - Wei-Wei Zhu
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China.,Graduate School of Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Hang Shen
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China
| | - Zhi-Yue Zhang
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China.,Graduate School of Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Li Ai
- Abbott Medical (Shanghai) Co. Ltd., Beijing, 100028, China
| | - Meng Wang
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, Beijing, 100142, China.,Graduate School of Hebei North University, Zhangjiakou, 075000, Hebei, China
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Montemezzo M, AlTurki A, Jakolinski M, Jorge JCM. Pacemaker Implantation without Fluoroscopy and Guided by Anatomical Mapping. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tamirisa KP, Elkayam U, Briller JE, Mason PK, Pillarisetti J, Merchant FM, Patel H, Lakkireddy DR, Russo AM, Volgman AS, Vaseghi M. Arrhythmias in Pregnancy. JACC Clin Electrophysiol 2022; 8:120-135. [PMID: 35057977 DOI: 10.1016/j.jacep.2021.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Abstract
Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.
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Affiliation(s)
| | - Uri Elkayam
- Keck School of Medicine, University of Southern California, California; Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, California, USA
| | - Joan E Briller
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Pamela K Mason
- Division of Cardiology/Electrophysiology, University of Virginia, Charlottesville, Virginia
| | | | - Faisal M Merchant
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hena Patel
- University of Chicago, Chicago, Illinois, USA
| | | | | | | | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA.
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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.
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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
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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.
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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
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Guo P, Qiu J, Wang Y, Chen G, Proietti R, Fadhle ALS, Zhao C, Wen Wang D. Zero-fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:122-127. [PMID: 29222861 DOI: 10.1111/pace.13248] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/19/2017] [Accepted: 11/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ping Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
- Division of Cardiology, Department of Internal Medicine; The Second Affiliated Hospital of Zhengzhou University; Zhengzhou P. R. China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Riccardo Proietti
- Division of Cardiology, Morriston Hospital; Swansea University; Swansea UK
- Division of Cardiology, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - AL-Selmi Fadhle
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
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Permanent pacemaker implantation without fluoroscopy in a pregnant woman with complete atrioventricular block: A case report. Indian Pacing Electrophysiol J 2016. [PMCID: PMC5153420 DOI: 10.1016/j.ipej.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 26-year-old pregnant woman in her first trimester presented with progressive fatigue. Her Electrocardiogram showed second degree heart block (Mobitz type II) with intermittent complete heart block. We decided to proceed with dual-chamber permanent pacemaker implantation using CARTO mapping system to avoid fluoroscopy exposure. A mapping catheter was inserted through the right femoral vein. An electro-anatomical map of cardiac chambers was created using the mapping catheter. Through left axillary vein access, the two pacemaker leads were successfully positioned guided by the electro-anatomical map. No complications were noted post procedure. Pacemaker was functioning appropriately at follow-up visits.
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Tuzcu V, Gul EE, Erdem A, Kamali H, Saritas T, Karadeniz C, Akdeniz C. Cardiac Interventions in Pregnant Patients without Fluoroscopy. Pediatr Cardiol 2015; 36:1304-7. [PMID: 25946984 DOI: 10.1007/s00246-015-1181-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac interventions with fluoroscopy during pregnancy carry significant risks for the fetus. This report reviews three pregnant patients: two of them requiring pacemaker implantation and one underwent diagnostic cardiac catheterization without fluoroscopy. METHODS The cases were performed using EnSite system (St. Jude Medical Inc., MN, USA) guidance. The necessary cardiac structure geometries were reconstructed with a deflectable quadripolar electrophysiology catheter without fluoroscopy. In two cases, pacemaker leads were connected to the EnSite system for navigation and fixation of leads. In the third case, long sheaths and electrophysiology catheters were used to access the right ventricle and pulmonary artery. Transthoracic echocardiography was also used in all three cases. RESULTS A 31-year-old woman at 8-week pregnancy was admitted with ventricular septal defect and significant pulmonary hypertension. The patient underwent catheterization to assess for the risk of continuation of pregnancy. There was partial reactivity, it was decided not to terminate the pregnancy, and an uneventful delivery was succeeded at 35 weeks of gestation without complications. The rest of the two pregnant patients were a 28-year-old pregnant woman at 14 weeks of gestation and a 40-year-old woman at 12-week gestation. Both of them presented with symptomatic complete AV block. A single-chamber pacemaker was implanted in the first one, and a dual-chamber pacemaker was implanted in the latter. Pregnancy continued in both without complications. CONCLUSION Successful cardiac catheterization and pacemaker implantation can be performed safely in selected pregnant patients using an electroanatomic mapping system guidance without fluoroscopy.
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Affiliation(s)
- Volkan Tuzcu
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University Hospital, Istanbul, Turkey
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Enriquez AD, Economy KE, Tedrow UB. Contemporary management of arrhythmias during pregnancy. Circ Arrhythm Electrophysiol 2015; 7:961-7. [PMID: 25336366 DOI: 10.1161/circep.114.001517] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Alan D Enriquez
- From the Cardiac Arrhythmia Service, Cardiovascular Division (A.D.E., U.B.T.) and Department of Obstetrics and Gynecology (K.E.E.), Brigham and Women's Hospital, Boston, MA
| | - Katherine E Economy
- From the Cardiac Arrhythmia Service, Cardiovascular Division (A.D.E., U.B.T.) and Department of Obstetrics and Gynecology (K.E.E.), Brigham and Women's Hospital, Boston, MA
| | - Usha B Tedrow
- From the Cardiac Arrhythmia Service, Cardiovascular Division (A.D.E., U.B.T.) and Department of Obstetrics and Gynecology (K.E.E.), Brigham and Women's Hospital, Boston, MA.
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Implantation of a defibrillator in a pregnant woman with hypertrophic cardiomyopathy under echocardiographic guidance: A case report. Int J Cardiol 2015; 179:323-4. [DOI: 10.1016/j.ijcard.2014.11.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/08/2014] [Indexed: 11/20/2022]
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Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA. Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease. Indian Pacing Electrophysiol J 2013; 13:34-7. [PMID: 23329872 PMCID: PMC3539398 DOI: 10.1016/s0972-6292(16)30586-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.
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Affiliation(s)
- Alejandro Velasco
- Internal Medicine Department. Texas Tech University Health Sciences Center, Lubbock, Texas. USA
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Renilla A, Barreiro M, Rubín JM, de la Hera JM. [Provisional pacemaker implantation guided by pocket echocardiography]. Med Intensiva 2012; 37:54-6. [PMID: 22683045 DOI: 10.1016/j.medin.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022]
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Abstract
Physiologic changes in maternal haemodynamics, hormones and autonomic properties contribute to arrhythmias in pregnancy. While arrhythmias most commonly occur in pregnant women with structural heart disease or those with a history of cardiac arrhythmias, they can also occur de novo in women with no documented cardiac disease.
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Vitarelli A, Capotosto L. Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy. Int J Cardiovasc Imaging 2010; 27:843-57. [PMID: 21082254 DOI: 10.1007/s10554-010-9750-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 01/10/2023]
Abstract
Congenital heart disease represent a large proportion of heart disease in pregnancy. With the exception of patients with Eisenmenger's syndrome, pulmonary vascular obstructive disease, and Marfan's syndrome with aortopathy, maternal death during pregnancy is rare in women with CHD but morbidity occurs such as heart failure, arrhythmias, and stroke. Echocardiography represents a milestone in diagnosis, understanding of pathophysiology, assessment of disease severity and patient monitoring in pregnant women with unoperated and post-operative congenital heart disease.
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Affiliation(s)
- Antonio Vitarelli
- Echocardiology Unit, Cardiac Department, Sapienza University, Via Lima 35, 00198, Rome, Italy.
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Cordina R, McGuire MA. Maternal cardiac arrhythmias during pregnancy and lactation. Obstet Med 2010; 3:8-16. [PMID: 27582834 PMCID: PMC4989762 DOI: 10.1258/om.2009.090021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2009] [Indexed: 11/18/2022] Open
Abstract
Arrhythmias occurring during pregnancy can cause significant symptoms and even death in mother and fetus. The management of these arrhythmias is complicated by the need to avoid harm to the fetus and neonate. It is useful to classify patients with arrhythmias into those with and without structural heart disease. Those with a primary electrical problem, but an otherwise normal heart, often tolerate rapid heart rates without compromise whereas patients with problems such as rheumatic heart disease, congenital heart disease or cardiomyopathy may quickly decompensate during an arrhythmia.
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Affiliation(s)
- Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital
- Department of Medicine, University of Sydney, Sydney, Australia
| | - Mark A McGuire
- Department of Cardiology, Royal Prince Alfred Hospital
- Department of Medicine, University of Sydney, Sydney, Australia
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Pedrinazzi C, Gazzaniga P, Durin O, Tovena D, Inama G. Implantation of a permanent pacemaker in a pregnant woman under the guidance of electrophysiologic signals and transthoracic echocardiography. J Cardiovasc Med (Hagerstown) 2008; 9:1169-72. [DOI: 10.2459/jcm.0b013e3283100edc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abello M, Peinado R, Merino JL, Gnoatto M, Mateos M, Silvestre J, Dominguez JL. Cardioverter defibrillator implantation in a pregnant woman guided with transesophageal echocardiography. Pacing Clin Electrophysiol 2003; 26:1913-4. [PMID: 12930513 DOI: 10.1046/j.1460-9592.2003.00293.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This report describes a 28-year-old pregnant woman with mitral valve prolapse and sudden cardiac death due to a ventricular fibrillation who underwent an ICD implantation guided by tranesophageal echocardiography.
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Affiliation(s)
- Mauricio Abello
- Laboratory of Clinical Cardiac Electrophisiology, Division of Cardiology, La Paz University Hospital, Madrid, Spain
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