Background: X-ray guided CRT device implantation is widely performed and the radiation dose may be elevated for operators and patients. Aim of the present study was to describe the usefulness of the electroanatomic approach to minimize the fluoroscopy exposure during CRT device implantation.
Methods: 25 patients with indication to CRT-D implantations, were used a steerable 5F catheter and a unipolar guidewire (visionwireTM) to perform the CS electroanatomic map. Local LV activation times were recorded from CS vessels during right ventricular pacing. Optimal pacing choice and final CS lead position were based on the maximum LV activation delay. Fluoroscopy time and dose were recorded.
Results:All the permanent pacing leads were successfully positioned aided by the mapping system (MS). X-rays were only used to check the final positions. In all cases CS os was identified and cannulated without X-ray. In 21 cases, geometry validation through angiography was performed afterwards. The average fluoroscopy time was 6.1 min.
Conclusion The implantation of a CRT device using a MS is feasible and reliable. In our experience we had a fluoroscopy reduction of 70%.