Europace Advance Access published online on June 3, 2008
Europace, doi:10.1093/europace/eun139
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Implantation of single-lead atrioventricular permanent pacemakers guided by electroanatomic navigation without the use of fluoroscopy
Arrhythmia and Cardiac Pacing Unit, Cardiology Department, Hospital Clinico Universitario, Av Blasco Ibanez, 17, 46010 Valencia, Spain
Aims: Fluoroscopy is the standard and almost unique tool used for cardiac imaging during permanent pacemaker implantation, and its use implies exposure of patients and operators to radiation. The usefulness for this purpose of electroanatomic systems not based on fluoroscopy is unknown. Our aim was to study the feasibility of implanting single-lead VDD pacemakers without the use of fluoroscopy.
Methods and results: EnSite NavX®, a catheter navigation tool based on the creation of a voltage gradient across the thorax of the patient, was used as an exclusive imaging tool during the implantation of single-lead atrioventricular (VDD) permanent pacemakers in 15 consecutive patients with atrioventricular block and normal sinus node function. A retrospective series of 15 consecutive patients in whom VDD pacemakers were implanted under fluoroscopic guidance was used as a control group. The pacemaker could be implanted in all patients. Time spent to obtain the right ventricle anatomy was 10.1 ± 5.4 min and time to place the lead in an adequate position was 10.1 ± 7.8 min. Total implant time was 59.3 ± 15.6 min (51.5 ± 12.3 min in the control group; P = 0.14). In one patient, a short pulse of radioscopy was needed for a correct catheterization of the subclavian vein. No complications were observed during the procedure. One lead dislodgement that required re-operation was detected 24 h after implantation. At 3 months follow-up, all pacemakers were functioning properly, with adequate pacing and sensing thresholds.
Conclusion: Electroanatomic navigation systems such as NavX can be used for cardiac imaging during single-lead atrioventricular pacemaker implantation as a reliable and safe alternative to fluoroscopy.
Key Words: Pacemaker, Non-fluoroscopy imaging, Heart block, Mapping, Electroanatomic navigation
* Corresponding author. Tel/fax: +34 963 862 658.E-mail address: ruiz_ric{at}gva.es
Manuscript submitted 11 March 2008. Accepted after revision 6 May 2008.