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Wang L, Li P, Li J, Xi J, Zhang Z, Yan F, Zhang Y, Wang H, Han H. Bedside zero-fluoroscopy temporary permanent pacemaker implantation in the electrical storm treatment under the guidance of EnSite 3D system: a case report. J Cardiothorac Surg 2024; 19:62. [PMID: 38321546 PMCID: PMC10845802 DOI: 10.1186/s13019-024-02579-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Electrical storm (ES) is a clinical emergency characterized by multiple malignant ventricular arrhythmias or ICD discharges within 24 h, requiring early rational management. CASE PRESENTATION We report a 55-year-old man who underwent aortic valve replacement experienced recurrent ventricular tachycardia/ventricular fibrillation. A temporary permanent pacemaker with the EnSite system was implanted, and significant inhibition of the electrical storm, attributed to the atrial overdrive pacing, ensued. CONCLUSIONS In emergency regarding an electrical storm, the bedside temporary permanent pacemaker implantation with the EnSite system is concluded to be feasible and safe.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, 18 Yifen Road, Taiyuan, Shanxi, 030001, China
| | - Pengfei Li
- Department of Cardiology, Xinzhou People's Hospital, Xinzhou, Shanxi, 034000, China
| | - Jun Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, 18 Yifen Road, Taiyuan, Shanxi, 030001, China
| | - Jicheng Xi
- Department of Cardiac Surgery, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, 030001, China
| | - Zhibiao Zhang
- Department of Cardiac Surgery, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, 030001, China
| | - Fang Yan
- Department of Cardiac Surgery, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, 030001, China
| | - Yanan Zhang
- Department of Critical Medicine, Shanxi Bethune Hospital, Taiyuan, Shanxi, 030001, China
| | - Haixiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, 18 Yifen Road, Taiyuan, Shanxi, 030001, China.
- Department of Cardiology, Xinzhou People's Hospital, Xinzhou, Shanxi, 034000, China.
| | - Huiyuan Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, 18 Yifen Road, Taiyuan, Shanxi, 030001, China
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2
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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.
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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
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3
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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4
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Ramos-Maqueda J, Melero-Polo J, Montilla-Padilla I, Ruiz-Arroyo JR, Cabrera-Ramos M. Feasibility and safety of zero-fluoroscopy left bundle branch pacing: An initial experience. J Cardiovasc Electrophysiol 2023; 34:429-436. [PMID: 36448425 PMCID: PMC10107534 DOI: 10.1111/jce.15765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Left bundle branch pacing (LBBP) has emerged in recent years as a new pacing modality, providing patients with a narrower paced QRS than conventional pacing and stable pacing parameters. At the same time, there is a growing concern about the use of fluoroscopy in pacemaker implantations, given its harmful effects on both patients and operators. However, there are no prior experiences of zero-fluoroscopy in LBBP procedure. METHODS We conducted an observational prospective study recruiting consecutive patients that underwent zero-fluoroscopy LBBP pacemaker implantation. A 6-month follow-up visit was programmed for every patient. The main goal of our study was to assess the efficacy, feasibility, and safety of the procedure. RESULTS From January 2021 to February 2022, we included 10 patients, 8 males. The average age was 63 ± 4 years. The procedure was successful in all patients. We observed a significant reduction in paced QRS width compared with basal QRS width (149 ± 31.9 vs. 116 ± 15.6 ms, p = .02). All device parameters remained stable at 6-month follow-up: no significant differences in mean impedance (700.5 ± 136.4 vs. 494 ± 72.7 Ohm, p = .09), capture threshold (0.67 ± 0.2 vs. 0.83 ± 0.2 V @ 0.4 ms, p = .27) or endocardial V-wave amplitude (10.6 ± 5.2 vs. 13.9 ± 6.3 mV, p = .19). No complications were reported in any case. CONCLUSION Zero-fluoroscopy LBBP is feasible and safe, and it may be considered in cases where radiation exposure is contraindicated or especially undesirable. Future randomized clinical trials are needed for the widespread use of this new technique.
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Affiliation(s)
- Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
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5
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Management of Complete Heart Block in a Pregnant Woman with Systemic Lupus Erythematosus-Associated Complications: Treatment Considerations and Pitfalls. Medicina (B Aires) 2022; 59:medicina59010088. [PMID: 36676711 PMCID: PMC9864118 DOI: 10.3390/medicina59010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
We present a case of a pregnant woman with systemic lupus erythematosus (SLE) who was diagnosed with asymptomatic complete heart block (CHB) during pregnancy. To evaluate possible risks and benefits of pacemaker (PM) implantation, a multidisciplinary counselling board was held. Its recommendation was to perform PM implantation to prevent intra-uterine growth restriction from insufficient cardiac output using a fluoroscopic protective shield. The procedure was performed without complications and established permanent pacing on onwards ECG examinations. The patient subsequently gave birth to a healthy newborn. After a retrospective clinical case evaluation and review of relevant literature, a presumptive association between CHB and the primary diagnosis was proposed. Above that, pregnant women with SLE who develop hypertension are commonly treated with methyldopa, which may cause conduction abnormalities. Clinical recommendations for young female patients expecting pregnancy are lacking in this area. Careful diagnostic and treatment approaches should be used in the management of possible SLE-related complications in women of child-bearing age, focusing on preventable events.
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6
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Scarà A, Golia P, Grieco D, Borrelli A, De Ruvo E, Bressi E, Politano A, De Luca L, Bruni G, Fagagnini A, Panuccio M, Rebecchi M, Zecchi P, Solimene F, Calò L, Sciarra L. Low fluoroscopy permanent His bundle pacing using a new electroanatomic mapping system (KODEX EPD). A multicenter experience. J Arrhythm 2022; 39:18-26. [PMID: 36733331 PMCID: PMC9885313 DOI: 10.1002/joa3.12803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
Background His bundle pacing (HBP) may be a challenging procedure, often involving a long fluoroscopic time (FT) and a long procedural time (PT). We sought to evaluate whether the use of a new nonfluroscopic mapping (NFM) system, the KODEX-EPD, is able to reduce FT and PT when mapping is performed by the pacing catheter rather than an electrophysiological mapping catheter. Methods and Results We included 46 consecutive patients (77 ± 8 years; 63% male) who underwent HBP; in 22 a NFM-guided procedure with the KODEX-EPD system was performed (group 1), whereas in 24 a conventional fluoroscopy-guided approach was used (group 2). Pacing indications were sick sinus syndrome in 13, atrioventricular block in 21, and cardiac resynchronization therapy in 12 cases. Both a lumen-less fixed helix lead and a stylet-driven extendable helix lead were used, respectively, in 24% and 76% of patients. HBP was successful in 22 patients (100%) in group 1 and 23 patients (96%) in group 2. The FT was significantly reduced in group 1 (183 ± 117 s vs 464.1 ± 352 s in group 2, p = .012). There were no significant differences between groups in PT and other procedural outcomes. Conclusions The KODEX-EPD system may be safely used in HBP procedures. It is effective in reducing ionizing radiation exposure, as evidenced by the significant drop in FT, without increasing PT.
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7
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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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8
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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.
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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.
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9
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Andreozzi E, Esposito D, Bifulco P. Contactless Electrocatheter Tracing within Human Body via Magnetic Sensing: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:3880. [PMID: 35632288 PMCID: PMC9146650 DOI: 10.3390/s22103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 01/25/2023]
Abstract
During surgical procedures, real-time estimation of the current position of a metal lead within the patient's body is obtained by radiographic imaging. The inherent opacity of metal objects allows their visualization using X-ray fluoroscopic devices. Although fluoroscopy uses reduced radiation intensities, the overall X-ray dose delivered during prolonged exposure times poses risks to the safety of patients and physicians. This study proposes a potential alternative to real-time visualization of a lead inside the human body. In principle, by making a weak current flow through the lead and measuring the related magnetic field generated outside the body, it is possible to trace the position of the lead. This hypothesis was verified experimentally via two tests: one carried out on a curved copper wire in air and one carried out on a real pacemaker lead in a saline solution. In the second test, a pacemaker lead and a large return electrode were placed in a tank filled with a saline solution that reproduced the mean resistivity of the human torso. In both tests, a current flowed through the lead, which consisted of square pulses with short duration, to avoid any neuro-muscular stimulation effects in a real scenario. A small coil with a ferrite core was moved along a grid of points over a plastic sheet and placed just above the lead to sample the spatial amplitude distribution of the magnetic induction field produced by the lead. For each measurement point, the main coil axis was oriented along the x and y axes of the plane to estimate the related components of the magnetic induction field. The two matrices of measurements along the x and y axes were further processed to obtain an estimate of lead positioning. The preliminary results of this study support the scientific hypothesis since the positions of the leads were accurately estimated. This encourages to deepen the investigation and overcome some limitations of this feasibility study.
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Affiliation(s)
| | | | - Paolo Bifulco
- Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Via Claudio, 21, 80125 Napoli, Italy; (E.A.); (D.E.)
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Rubenstein DS, Holmes BB, Manfredi JA, McKillop MS, Netzler PC, Ward CC. Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination-review and commentary. J Interv Card Electrophysiol 2022; 64:239-253. [PMID: 35258751 PMCID: PMC9236987 DOI: 10.1007/s10840-022-01173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Donald S Rubenstein
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA.
| | - Benjamin B Holmes
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Joseph A Manfredi
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Matthew S McKillop
- Baptist Medical Center Jacksonville, 800 Prudential Dr., Jacksonville, FL, 32207, USA
| | - Peter C Netzler
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Chad C Ward
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
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11
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Senarath S, Nanayakkara P, Beale AL, Watts M, Kaye DM, Nanayakkara S. Diagnosis and management of arrhythmias in pregnancy. Europace 2021; 24:1041-1051. [PMID: 34904149 DOI: 10.1093/europace/euab297] [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] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Arrhythmias are the most common cardiac complications occurring in pregnancy. Although the majority of palpitations in pregnancy may be explained by atrial or ventricular premature complexes, the full spectrum of arrhythmias can occur. In this article, we establish a systematic approach to the evaluation and management of arrhythmias in pregnancy. Haemodynamically unstable arrhythmias warrant urgent cardioversion. For mild cases of benign arrhythmia, treatment is usually not needed. Symptomatic but haemodynamically stable arrhythmic patients should first undergo a thorough evaluation to establish the type of arrhythmia and the presence or absence of structural heart disease. This will ultimately determine the necessity for treatment given the potential risks of anti-arrhythmic pharmacotherapy in pregnancy. We will discuss the main catalogue of anti-arrhythmic medications, which have some established evidence of safety in pregnancy. Based on our appraisal, we provide a treatment algorithm for the tachyarrhythmic pregnant patient.
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Affiliation(s)
- Sachintha Senarath
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Pavitra Nanayakkara
- Department of Obstetrics and Gynaecology, The Epworth Hospital, Richmond, Victoria, Australia
| | - Anna L Beale
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Monique Watts
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - David M Kaye
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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12
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Sogade OO, Aben RN, Eyituoyo H, Arinze NC, Sogade FO. Feasibility study for echocardiography-guided lead insertion for permanent cardiac implantable electronic devices. Pacing Clin Electrophysiol 2021; 44:1365-1370. [PMID: 34121208 PMCID: PMC8457189 DOI: 10.1111/pace.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Omolade O Sogade
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rieta N Aben
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Harry Eyituoyo
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Nkechi C Arinze
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Felix O Sogade
- Georgia Arrhythmia Consultants, Macon, Georgia, USA.,Department of Medicine, Mercer University School of Medicine, Macon, Georgia, USA
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13
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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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14
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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.
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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
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15
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Paech C, Schnappauf D, Gehre T, Wagner F, Gebauer RA. Use of the Abbott EnSite Precision three-dimensional mapping system for the placement of an atrial pacemaker lead in a patient with congenital heart disease. Ann Pediatr Cardiol 2019; 12:130-131. [PMID: 31143037 PMCID: PMC6521657 DOI: 10.4103/apc.apc_138_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the use of the Abbott three-dimensional mapping system (EnSite Precision) for the placement of an atrial pacemaker lead in a patient after modified Fontan procedure. The mapping system was used for the identification of a promising pacing site in the complexly modified right atrium and to visualize the successful placement of an atrial lead at the same spot.
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Affiliation(s)
- Christian Paech
- Department of Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Dirk Schnappauf
- Department of Therapy Specialists, EP, Abbott Medical GmbH, Eschborn, Germany
| | - Tim Gehre
- Department of Therapy Specialists, EP, Abbott Medical GmbH, Eschborn, Germany
| | - Franziska Wagner
- Department of Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Roman Antonin Gebauer
- Department of Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
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