Key result
Contrast-free electroanatomic mapping guides feasible CRT-D implantation and may optimize LV lead placement.
Why the study?
Contrast-induced acute kidney injury is a serious complication during CRT implantation, especially in patients with CKD, motivating alternative guidance methods without contrast infusion.
Does electroanatomic mapping system guidance allow for cardiac resynchronization therapy device implantation when contrast medium infusion is contraindicated?
Does electroanatomic mapping system guidance allow for cardiac resynchronization therapy device implantation when contrast medium infusion is contraindicated?
Electroanatomic mapping may provide an alternative guidance method for CRT implantation in patients with contraindications to iodine contrast medium.
May enable contrast-free CRT in select patients; leaves open need for prospective validation of safety and efficacy.
Introduction The implantation of transvenous leads for pacemakers and defibrillators is traditionally performed using fluoroscopic guidance. When cardiac resynchronization therapy (CRT) is indicated, iodine contrast medium (ICM) infusion for coronary sinus (CS) branch visualization is also needed. Adverse reactions to ICM during cardiac catheterization and coronary interventions are common. Chronic kidney disease (CKD) is frequently present in a population with symptomatic heart failure. Contrast-induced acute kidney injury is a serious and frequent procedural complication of CRT implantation with a significant negative influence on long-term survival. The feasibility of cardiac resynchronization therapydefibrillator (CRT-D) implantation guided by an advanced electroanatomic mapping system (MS), without contrast liquid infusion, is already reported in the literature. Moreover, using the MS to find the latest left ventricle activation site, it is possible to optimize the left ventricle (LV) lead position.
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Calzolari et al. (2016) studied Symptomatic heart failure with indications for cardiac resynchronization therapy. Electroanatomic mapping system-guided CRT-D implantation without contrast infusion was evaluated. Cardiac resynchronization therapy-defibrillator implantation guided by an electroanatomic mapping system without contrast is feasible and may optimize left ventricular lead position.
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