ABSTRACT
Pulmonary vein isolation (PVI) is used for rhythm control in atrial fibrillation (AF). Posterior wall isolation (PWI) is often an adjunct to PVI. Successful PWI is limited by esophageal location, epicardial bridging signals, tissue thickness, and mapping catheter resolution. High-density grid mapping catheters can assist with PWI. Here, we report a case of a 71-year-old woman with persistent AF who underwent PVI and PWI with high-density grid mapping catheters, thus demonstrating the use of omnipolar technology in facilitating successful PWI.
ABSTRACT
BACKGROUND: The conventional method of device implantation requires fluoroscopic guidance. With the guidance of three-dimensional (3-D) navigation systems, devices can be implanted with minimal use of fluoroscopy. To date, this technique has been reported in several case reports in young, pregnant patients. However, this technique has not been widely utilized by electrophysiologists, despite offering several benefits, including reduced radiation exposure for the patient and the operator. METHODS: In this study, we evaluated 18 patients who successfully underwent device implantation with limited use of fluoroscopy under the guidance of the EnSite Precision 3-D mapping navigation system (Abbott, St. Paul, MN, USA). In most of the patients, the total fluoroscopy time was 1 s, accounted by a single postprocedural frame to insure appropriate lead placement. RESULTS: A total of 19 leads were implanted in 18 patients (14 male, four female) using the electroanatomical mapping (EAM)-guided technique. A total of 19 leads were implanted in 15 patients (10 male, five female) using the conventional method. The average length of stay was 1.20 days in the EAM group compared to 1.47 days in the conventional group (P = .10). Majority of the devices implanted in both groups were single-chamber implantable cardiac defibrillators (VVI ICD, Abbott) implanted for cardiomyopathy with left ventricular ejection fraction persistently below 35%, including 88% (16/18) in the EAM group compared to 73% (11/15) in the conventional group. No periprocedural or immediate postprocedure complications were reported in either group. Device parameters, including impedance, capture time, and capture voltage, showed no significant difference in either group. Total radiation time and radiation dose were markedly lower in the EAM-guided implantation group. CONCLUSIONS: In patients who meet appropriate criteria for device implantation, the use of EAM system offers a safe, practical, efficacious alternative method to device implantation, with significant reduction in radiation time and dose.
