How to perform electroanatomic mapping-guided cardiac resynchronization therapy using Carto 3 and ESI NavX...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Cardiac Resynchronization Therapy with a defibrillator (CRT-D) implantation is crucial for heart failure management.
• Conventional fluoroscopic approaches involve significant radiation exposure and contrast dye usage.
• Minimizing fluoroscopy and contrast is essential for patient safety and procedural efficiency.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel protocol for low-fluoroscopy, electroanatomic mapping (EAM)-guided CRT-D implantation.
• To assess the utility of both EnSite NavX and Carto 3 mapping systems in this protocol.

Main Methods:

• A comparative study involving 20 patients undergoing CRT-D implantation.
• Patients were divided into conventional fluoroscopic approach (CFA) and EAM-guided groups.
• Key metrics compared included fluoroscopy time, procedural time, contrast dose, QRS duration changes, and complications.

Main Results:

• EAM-guided implantation resulted in an 86% reduction in fluoroscopy time compared to CFA (5.5 min vs. 37.2 min).
• Radiopaque contrast usage was significantly lower in the EAM group (4 mL vs. 16 mL).
• No significant differences were observed in procedural time or QRS duration changes between the groups.

Conclusions:

• Electroanatomic mapping-guided lead placement is a feasible and safe alternative to conventional fluoroscopic methods for CRT-D implantation.
• The described protocol effectively reduces radiation exposure and contrast media.
• This approach offers a promising advancement in CRT-D implantation techniques.