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Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease.

Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA - Indian Pacing Electrophysiol J (2013)

Bottom Line: Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age.We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker.This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department. Texas Tech University Health Sciences Center, Lubbock, Texas. USA.

ABSTRACT
Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

No MeSH data available.


Related in: MedlinePlus

Anterior and right anterior oblique views of the patient's heart showing the position of both pacemaker leads. SVC: Superior Vena Cava AR: Right Atria PM RA: Right Atrial Lead RVOT: Right ventricular outflow tract PM RVOT: Right ventricle lead
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Figure 2: Anterior and right anterior oblique views of the patient's heart showing the position of both pacemaker leads. SVC: Superior Vena Cava AR: Right Atria PM RA: Right Atrial Lead RVOT: Right ventricular outflow tract PM RVOT: Right ventricle lead

Mentions: We decided to implant a dual chamber permanent pacemaker. To minimize the X-ray exposure, we used an electroanatomic navigation system ENSITE NavX® System (Endocardial Solutions Inc., USA) during pacemaker implantation. A written informed consent was obtained from the patient. Three pairs of adhesive electrodes were placed on the patient chest to create the electrical field needed to create the navigation field. Under local anesthesia, two left subclavian punctures were performed, and a quadripolar steerable catheter was advanced through the sheath (IBI-83405, 7 Fr., 2.3 mm. Irvine Biomedical Inc., St. Jude Medical, USA). Contours of the superior vena cava, right atrium, tricuspid annulus, right ventricular apex and right ventricular outflow tract were created with the quadripolar catheter. The quadripolar catheter was then withdrawn, and an 8 Fr. replaced the 7 Fr. introducer. To visualize the atrial and ventricular leads, two cables were used with alligator clips attached to the pacemaker leads and a 2 mm pin end attached to the Ensite NavX® polygraph box. By being attached to the polygraph box, the leads were visualized as catheters within the electroanatomic contour. An active fixation ventricular lead (Tendril ST 58 cm, St. Jude Medical, USA) was advanced using the electroanatomic images as a reference and was placed in the right ventricular outflow tract. An R wave of 4.8 mV, a threshold of 0.5 V, and an impedance of 357 ohms in bipolar mode were documented after implantation. A second introducer was advanced, and an active fixation atrial lead (Tendril ST 52cm, St Jude Medical, USA) was positioned guided by the electroanatomic map. A P wave of 6.5 mV, a threshold of 1.2 V, and an impedance of 481 ohms in bipolar mode were obtained. Three-dimensional map documenting the final position of both leads is shown (Figure 2). The position of the electrodes was verified by the P wave and QRS morphology during pacing. Fluoroscopy for 5 seconds was performed to confirm active fixation deployment and lead positioning. Safety precautions for the baby were taken with a lead apron placed over the mother's abdominal area to minimize radiation exposure. Electrodes were connected to a Zaphyr pacemaker (St. Jude Medical) in the DDDR mode.


Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease.

Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA - Indian Pacing Electrophysiol J (2013)

Anterior and right anterior oblique views of the patient's heart showing the position of both pacemaker leads. SVC: Superior Vena Cava AR: Right Atria PM RA: Right Atrial Lead RVOT: Right ventricular outflow tract PM RVOT: Right ventricle lead
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539398&req=5

Figure 2: Anterior and right anterior oblique views of the patient's heart showing the position of both pacemaker leads. SVC: Superior Vena Cava AR: Right Atria PM RA: Right Atrial Lead RVOT: Right ventricular outflow tract PM RVOT: Right ventricle lead
Mentions: We decided to implant a dual chamber permanent pacemaker. To minimize the X-ray exposure, we used an electroanatomic navigation system ENSITE NavX® System (Endocardial Solutions Inc., USA) during pacemaker implantation. A written informed consent was obtained from the patient. Three pairs of adhesive electrodes were placed on the patient chest to create the electrical field needed to create the navigation field. Under local anesthesia, two left subclavian punctures were performed, and a quadripolar steerable catheter was advanced through the sheath (IBI-83405, 7 Fr., 2.3 mm. Irvine Biomedical Inc., St. Jude Medical, USA). Contours of the superior vena cava, right atrium, tricuspid annulus, right ventricular apex and right ventricular outflow tract were created with the quadripolar catheter. The quadripolar catheter was then withdrawn, and an 8 Fr. replaced the 7 Fr. introducer. To visualize the atrial and ventricular leads, two cables were used with alligator clips attached to the pacemaker leads and a 2 mm pin end attached to the Ensite NavX® polygraph box. By being attached to the polygraph box, the leads were visualized as catheters within the electroanatomic contour. An active fixation ventricular lead (Tendril ST 58 cm, St. Jude Medical, USA) was advanced using the electroanatomic images as a reference and was placed in the right ventricular outflow tract. An R wave of 4.8 mV, a threshold of 0.5 V, and an impedance of 357 ohms in bipolar mode were documented after implantation. A second introducer was advanced, and an active fixation atrial lead (Tendril ST 52cm, St Jude Medical, USA) was positioned guided by the electroanatomic map. A P wave of 6.5 mV, a threshold of 1.2 V, and an impedance of 481 ohms in bipolar mode were obtained. Three-dimensional map documenting the final position of both leads is shown (Figure 2). The position of the electrodes was verified by the P wave and QRS morphology during pacing. Fluoroscopy for 5 seconds was performed to confirm active fixation deployment and lead positioning. Safety precautions for the baby were taken with a lead apron placed over the mother's abdominal area to minimize radiation exposure. Electrodes were connected to a Zaphyr pacemaker (St. Jude Medical) in the DDDR mode.

Bottom Line: Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age.We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker.This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department. Texas Tech University Health Sciences Center, Lubbock, Texas. USA.

ABSTRACT
Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

No MeSH data available.


Related in: MedlinePlus