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Fluoroscopy reduction during device implantation by using three-dimensional navigation. A single-center experience.

Timothy R Larsen1, Aditya Saini1, Jessica Moore2

  • 1Pauley Heart Center, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia.

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Three-dimensional electroanatomic mapping (3DM) significantly reduces fluoroscopy time and radiation dose during cardiac device implantation procedures. This advanced imaging technique offers a safer alternative for patients and clinicians.

Keywords:
3-dimensional electroanatomical mappingcardiac mappingfluoroscopyimplantable defibrillatorimplantable devicespacemaker

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Fluoroscopy use in cardiac device implantation contributes to radiation exposure.
  • Nonfluoroscopic three-dimensional electroanatomic mapping (3DM) systems have shown promise in reducing radiation during ablation procedures.
  • The efficacy of 3DM in routine device implantation warranted investigation.

Purpose of the Study:

  • To evaluate the effectiveness of 3DM in reducing fluoroscopy time and radiation dose during routine cardiac device implantation.
  • To compare outcomes between 3DM-guided and standard fluoroscopy-guided device implantations.

Main Methods:

  • A prospective study involving 70 patients undergoing 3DM-guided device implantation (Ensite system).
  • Comparison with 70 historical control patients who underwent standard fluoroscopy (FL)-guided implantation.
  • Mapping of cardiac structures and real-time lead advancement visualization using 3DM.

Main Results:

  • 3DM significantly reduced median fluoroscopy time across single-chamber, dual-chamber, and biventricular device implantations (e.g., 0.9 min vs. 5.5 min for single-chamber).
  • Median radiation dose (air kerma) was substantially lower with 3DM compared to FL (e.g., 4 mGy vs. 15.4 mGy for single-chamber).
  • No procedural complications were reported, and lead performance at 3-month follow-up was comparable between groups.

Conclusions:

  • Three-dimensional electroanatomic mapping is a valuable tool for significantly decreasing fluoroscopy time and radiation exposure in routine cardiac device implantation.
  • 3DM provides a safe and effective alternative to standard fluoroscopy for device placement procedures.