Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination—review and commentary

Figures

• 

  Fig. 1. A MRI of the cervical spine of CRM device representative only a few years after starting employment. Arrow points to the cervical spine disc herniation. B Lateral spine x-ray following repair of herniation in A. C MRI of the lumbar spine of electrophysiologist with new disc herniation at L4-L5. A prior repair is seen with fusion and titanium cage at L5-S1 that was required approximately 5 years after starting practice. D Sagittal view of the lumbar spine of C

• 

  Fig. 2. Example of a 3D electroanatomic voltage map of the right atrium and right ventricle RAO and LAO positions constructed with HD Advisor Mapping Catheter. Purple identifies regions of highest amplitude voltages representing good targets for CRM lead positioning. SVC, superior vena cava; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; CS, coronary sinus

• 

  Fig. 3. Example of a transparent 3D anatomic map with Carto EAM of right atrium and ventricle with temporary electrophysiologic pacing catheters in the right ventricle and coronary sinus. Double click on the image to animate rotation

• 

  Fig. 4. Upper left panel: transcutaneous images with color Doppler flow of left subclavian vein (blue vessel). Upper right panel: the same vessel was confirmed to be venous with ease of compressibility and digital pressure over the lumen. Lower panels (figure obtained with permission from common license) [41]. Transcutaneous ultrasound shows direct visualization of access needle insertion into a central venous vessel to a proper depth

• 

  Fig. 5. Pacemaker leads are located within the chambers of the heart [16] (reproduced by CC-BY-NC license 5250881328925 from John Wiley and Sons). Top panel, right atrial pacemaker lead in the tip of right atrial appendage (RAA). Bottom panel, right ventricular pacemaker lead in right ventricle at the mid septal position

• 

  Fig. 6. A ICE imaging of coronary sinus (CS) and cannulation of the catheter. Left panel, ICE image from within right atrium (RA) shows CS os. Right panel, the orientation of ICE catheter from within RA (from St. Jude brochure of ViewFlex Xtra ICE Catheter). B An electrophysiologic wire enters CS in a long-axis view. Image shown is courtesy of Mansour Razminia

• 

  Fig. 7. Placement of CS lead via 3D electroanatomic mapping. Activation timing measurements for selecting the best vein branch for resynchronization (reproduced with permission) [61]. IIV, inferior inter-ventricular vein; ILV, inferolateral vein; ALV, anterolateral vein; AIV, anterior inter-ventricular vein