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.
Subject(s)
Cardiac Pacing, Artificial , Electrophysiologic Techniques, Cardiac , Imaging, Three-Dimensional , Pacemaker, Artificial , Radiation Dosage , Radiation Exposure/prevention & control , Radiography, Interventional , Aged , Cardiac Resynchronization Therapy , Cardiac Resynchronization Therapy Devices , Databases, Factual , Fluoroscopy , Humans , Male , Patient Safety , Radiation Exposure/adverse effects , Radiography, Interventional/adverse effects , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , VirginiaABSTRACT
BACKGROUND: Implantable cardioverter defibrillators (ICDs) must establish a balance between delivering appropriate shocks for ventricular tachyarrhythmias and withholding inappropriate shocks for lead-related oversensing ("noise"). To improve the specificity of ICD therapy, manufacturers have developed proprietary algorithms that detect lead noise. The SecureSenseTM RV Lead Noise discrimination (St. Jude Medical, St. Paul, MN, USA) algorithm is designed to differentiate oversensing due to lead failure from ventricular tachyarrhythmias and withhold therapies in the presence of sustained lead-related oversensing. METHODS AND RESULTS: We report 5 patients in whom appropriate ICD therapy was withheld due to the operation of the SecureSense algorithm and explain the mechanism for inhibition of therapy in each case. Limitations of algorithms designed to increase ICD therapy specificity, especially for the SecureSense algorithm, are analyzed. CONCLUSION: The SecureSense algorithm can withhold appropriate therapies for ventricular arrhythmias due to design and programming limitations. Electrophysiologists should have a thorough understanding of the SecureSense algorithm before routinely programming it and understand the implications for ventricular arrhythmia misclassification.
Subject(s)
Algorithms , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Electrophysiologic Techniques, Cardiac/methods , Signal Processing, Computer-Assisted , Signal-To-Noise Ratio , Aged , Arrhythmias, Cardiac/physiopathology , Defibrillators, Implantable , Electric Countershock , Equipment Failure , Female , Humans , Predictive Value of Tests , Prosthesis Design , Reproducibility of Results , Software Design , Treatment OutcomeSubject(s)
Defibrillators, Implantable , Electric Countershock/instrumentation , Heart Rate , Sick Sinus Syndrome/therapy , Ventricular Premature Complexes/therapy , Aged, 80 and over , Algorithms , Atrial Function , Electrophysiologic Techniques, Cardiac , Humans , Male , Predictive Value of Tests , Prosthesis Design , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/physiopathology , Signal Processing, Computer-Assisted , Telemetry , Treatment Outcome , Ventricular Function , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/physiopathologyABSTRACT
A 70-year-old man with atrial fibrillation underwent pulmonary vein (PV) isolation (PVI). Bigeminal concealed PV depolarizations persisted within the right superior PV throughout the PVI. Though the PV depolarizations was suppressed after successful PVI, PV depolarization, following a slow intrinsic PV automatic rhythm, was observed. The coupling interval of the PV depolarizations during the PV automaticity was identical to that of the PV depolarizations during sinus rhythm before the PVI. This case demonstrated that PV depolarization does not always depend on an intact left atrial input, but may depend on some types of triggering electrical activity.
Subject(s)
Atrial Fibrillation/physiopathology , Atrial Fibrillation/therapy , Catheter Ablation/methods , Pulmonary Veins/physiopathology , Aged , Cardiac Catheterization , Electrophysiologic Techniques, Cardiac , Humans , MaleABSTRACT
A 63-year-old woman with symptomatic premature ventricular contractions (PVCs) underwent electrophysiologic testing. The PVCs were suggested to originate from the infra-aortic valvular left ventricular outflow tract because the PVCs had S-waves in leads I, V5, and V6, and an R/S ratio >1 in lead V(1). However, during some PVCs without S-waves, the ST segment had negative retrograde P-waves with a longer ventricularatrial (VA) interval. A Radiofrequency (RF) application in the left coronary cusp completely eliminated the PVCs, suggesting that negative retrograde P-waves might have been observed as pseudo S-waves during the PVCs.