Key result
Combined ICE and CARTO mapping enables safe, contrast-free dual-chamber leadless pacemaker implantation in CKD.
Why the study?
Contrast-free dual-chamber leadless pacemaker implantation techniques are needed for near-dialysis-stage chronic kidney disease patients in whom contrast is contraindicated.
Does contrast-free implantation using intracardiac echocardiography and 3-dimensional electroanatomical mapping enable safe dual-chamber leadless pacemaker placement in patients with severe chronic kidney disease?
Case Report
Does contrast-free implantation using intracardiac echocardiography and 3-dimensional electroanatomical mapping enable safe dual-chamber leadless pacemaker placement in patients with severe chronic kidney disease?
Intracardiac echocardiography combined with 3-dimensional electroanatomical mapping allows for safe, contrast-free dual-chamber leadless pacemaker implantation, offering a new procedural strategy for patients with severe kidney disease.
Answers are grounded in this paper and cite their sources.
Offers contrast-free leadless pacemaker implantation option in advanced CKD; leaves open need for prospective validation before adoption.
OBJECTIVE: The authors aim to describe contrast-free dual-chamber leadless pacemaker implantation using combined intracardiac echocardiography (ICE) and CARTO three-dimensional electroanatomical mapping in near-dialysis-stage chronic kidney disease cases. KEY STEPS: 1) Noncontrast computed tomography reconstruction imported into CARTO as an anatomical roadmap; 2) ICE-guided 3D right-heart geometry reconstruction with color-tagged targets; 3) Aveir VR implantation at the mid-interventricular septum under ICE/CARTO co-registration with echo-fan-guided advancement; 4) Aveir AR implantation at the right atrial appendage base using pectinate muscles as landmarks; 5) sequential impedance monitoring as a tissue-contact surrogate. POTENTIAL PITFALLS: The echo fan must be directed toward the septum, not the right ventricular apex, before advancing the catheter; misalignment may cause apical fixation. Accurate right atrial appendage base identification via pectinate muscles is essential to avoid fixation at insufficiently thick myocardium. TAKE-HOME MESSAGE: Combined ICE and CARTO 3-dimensional electroanatomical mapping enables safe, contrast-free dual-chamber leadless pacemaker implantation in chronic kidney disease cases, potentially expanding this therapy to patients in whom contrast is contraindicated.
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Kikuchi et al. (2026) conducted a case report in Chronic kidney disease requiring pacemaker implantation. Contrast-free dual-chamber leadless pacemaker implantation using combined ICE and CARTO 3D mapping was evaluated. Combined ICE and CARTO 3-dimensional electroanatomical mapping enables safe, contrast-free dual-chamber leadless pacemaker implantation in patients with chronic kidney disease.
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