Pacemaker implantation using electroanatomical mapping system Carto 3: technical protocol, single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background / Purpose: Three-dimensional electro-anatomical mapping systems (EAM) reduce fluoroscopy exposure during ablation procedures. The aim of this study is to evaluate the security and feasibility of performing pacemaker implantation with EAM routinely on a more regular basis (without fluoroscopy) and to draft a technical protocol to perform these implants. Methods Eight non-selected patients with pacemaker indication that had been referred to the electrophysiology unit of our institution underwent a dual chamber pacemaker implantation with EAM system Carto 3 (Biosense Webster, Irvine, CA, USA). All implants were performed by the same operator and, in all cases, the same lead model was employed. All difficulties that arose during the implantations were solved applying the actions contained in the protocol described below. First - Creation of three anatomical maps with Carto 3: venous access, right atrium and right ventricle. Annotate the end of the venous sheath. Second- For right ventricle lead positioning, connect the pacemaker lead to the Carto 3 system as an external catheter. Place the right ventricle lead, fix it and perform measurements. Third - Fuse the three maps with the "anatomical merge" tool. Fourth - Using the "design line" tool, draw a line from the tip of the lead to the end of the venous sheath following the expected trajectory of the lead in its correct position. Measure that distance. Calculate (substrate) the theoretically remaining lead. Fifth - With a ruler, measure the portion of the lead remaining out of the sheath. Sixth - Reposition the lead, if necessary. Seventh - Repeat the same procedure for the atrial lead and complete the implant procedure. Finally - Verify leads position with fluoroscopy (optional). Results : Eight patients received a dual chamber pacemaker, 75% male with a mean age 82,88 ±4,97 years. The most frequent indication was AV block (75%). The implant was performed through cephalic vein access (37,5%), subclavian vein access (50%). Mean procedure time (skin to skin) was 94 ±15 minutes. There were no complications related to the implant nor was it necessary to replace the lead. Conclusions : Pacemaker implantation with Carto 3 is a safe and reliable. The learning curve is not steep and the operator should be confident enough only after a few procedures. The protocol developed facilitates the implant procedure. Fluoroscopy timeCase12345678Fluoroscopy time (s)474786246060Dose area product (Gy*cm2)4,270,3710,0290,0630,0630,020,1230,018Abstract Figure. Carto image: dual chamber pacemaker.

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Myocardial biomechanics, intracardiac hemodynamics and endothelial function in patients before and after various types of pacemakers implantation

Cardiosomatics ◽

10.26442/22217185.2019.2.190307 ◽

2019 ◽

Vol 10 (2) ◽

pp. 56-63

Author(s):

Viktoriia A. Sanakoyeva ◽

Maksim S. Rybachenko ◽

Alena A. Pukhayeva ◽

Aleksandr G. Avtandilov

Keyword(s):

Endothelial Function ◽

Right Ventricle ◽

Acute Hypoxia ◽

Small Sample ◽

Lv Function ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Ventricular Stimulation ◽

The Right ◽

Stimulation Of

This review presents 31 sources from 1995 to 2019. Atrioventricular blockades (AVB) 2-3 degrees occupy a special place among the causes of death from cardiovascular disease. The above AVB lead to a significant slowing of the heart rate and predispose to the development and progression of heart failure (HF) and the occurrence of acute hypoxia of the brain and attacks Morgagni-Adams-Stokes. The main method of treatment of hemodynamically significant AB-conduction disorders is electrocardiostimulation (ES), which is the basic method of treatment. A single chamber pacemaker is the most often implanted with using isolated ventricular stimulation in clinical practice in the Russian Federation. Implantation of a dual chamber pacemaker is less frequent. This type of stimulation allows to maintain atrioventricular synchronization constantly. Stimulation of the apex of the right ventricle leads to a decrease in left ventricle (LV) function and structural changes that are a consequence of the occurrence of electric and mechanical dyssynchrony of the myocardium. There is a large number of works devoted to the comparison of different methods of ES leading to the conclusion that a powerful alternative to the stimulation of the apex of the right ventricle can be a dual ventricular stimulation. It is noted that implantation of single-and dual-chamber pacemaker with fixation of the electrode in the region of the right ventricle apex leads to the fact that both modes of stimulation can not cancel the electrical and anatomical remodeling of the myocardium of left atrium and LV. It may be necessary to use a more physiological site of stimulation with using optimal AB-delay to minimize the frequency of ventricular stimulation. Endothelium plays an important and independent role in the development of cardiovascular diseases. The effect of AB conduction impairment on endothelial function (EF) has not been described to date. There were few studies which are discussed the influence of constant pacemaker on endothelial function in patients with AVB 2-3 degrees in recent years. It should be noted that the studies were conducted on a small sample of patients and had a different design.

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Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes

EP Europace ◽

10.1093/europace/euab116.377 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Jelisejevas ◽

A Breitenstein ◽

D Hofer ◽

S Winnik ◽

J Steffel ◽

...

Keyword(s):

Pacemaker Implantation ◽

Patient Characteristics ◽

Venous Access ◽

Femoral Access ◽

Funding Sources ◽

Leadless Pacemaker ◽

Leadless Pacing ◽

Procedural Success ◽

The Right ◽

Transfemoral Tavi

Abstract Funding Acknowledgements Type of funding sources: None. Background Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, Leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left sided femoral venous approach may benecessary. We hypothesized that a left sided femoral venous approach is as safe and effective as compared to a right sided approach. Objective We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach as compared to the conventional right sided approach. Methods and Results: In this retrospective single-center analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases as compared to 8% in the remaining population (p = 0.003). Final leadless pacemaker position within the right ventricle was mid-septal in 82% (102/125) for right femoral access vs 72% (13/18) for left femoral access (p = 0.16). In the remaining cases (28 %, 5/18), the device was placed infero-septal following a left femoral venous access, as compared to 14% (18/125) for a right sided approach (p = 0.19). No repositioning was needed in 68% (85/125) using a right femoral access vs 72% (13/ 18) patients with a left femoral access (p = 0.84). Conclusions A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left- vs. right femoral venous access was a previous transfemoral TAVI procedure.

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Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava

Acta Cardiologica ◽

10.1080/ac.69.2.3017311 ◽

2014 ◽

Vol 69 (2) ◽

pp. 220-221

Author(s):

Christophe Garweg ◽

David Derthoo ◽

Rik Willems

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Pacemaker Implantation ◽

Vena Cava ◽

Dual Chamber ◽

Left Superior Vena Cava ◽

Dual Chamber Pacemaker ◽

Persistent Left Superior Vena ◽

The Right

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Is the right ventricular function affected by permanent pacemaker?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.003 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

N Bachani ◽

A Bagchi ◽

K Sinkar ◽

JP Jadwani ◽

GK Panicker ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Pacemaker Implantation ◽

Three Dimensional ◽

Av Block ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Rv Pacing ◽

Rv Function

Abstract Funding Acknowledgements Type of funding sources: None. Background The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, and so has the effect of the RV pacing lead on tricuspid valve function. However, the effects on RV function per se have not been evaluated systematically. Purpose We aimed to assess the RV dimensions and RV function six months after dual chamber pacemaker implantation performed for atrioventricular (AV) block by detailed echocardiography, including three-dimensional (3D) echocardiography. Method All adult patients undergoing dual chamber pacemaker from January 2018 to March 2019 for symptomatic AV block with a structurally normal heart were included in the study. They underwent pre-procedure detailed echocardiography specifically directed at measuring RV dimensions and function [including 3D RV ejection fraction (EF)] and a repeat detailed echocardiogram at six-month follow-up, by the same echocardiographer. The echocardiographic parameters at baseline and after six-month follow-up were compared. Results All patients had more than 75% ventricular pacing in these six months. At six-month follow-up, there was no significant change in LVEF, while there was a mild decrease in RVEF as outlined in the Table 1. While there was some overlap between RVEF range of values at baseline and after six months, 23 (38.3%) patients showed a drop in RVEF by >5%. Conclusion Our study shows a change in several RV function parameters in a majority of patients six months after pacemaker implantation for AV block. RV Function at six month follow-up Parameters Pre-procedure Six-Month Follow-up p value (Paired t-test) PASP (mm Hg) 20.2 ± 1.3 26.1 ± 12.2 <0.001 FAC (%) 42.6 ± 3.4 39.4 ± 6 <0.001 TAPSE (mm) 18.4 ±3.8 15.6 ± 4.7 <0.001 RIMP 0.66 ± 0.09 0.61 ± 0.11 0.003 RV E/E’ 9.4 ± 2.1 7.7 ± 2.1 <0.001 RV S’ 13.6 ± 2.4 10.7 ± 2.4 <0.001 RVEF % [By 3D Echocardiography] 47.7± 5.1 44.9 ± 7.4 <0.001 TR Jet Area (cm2) 0.03 ± 0.26 0.55 ± 0.96 <0.001 RV= Right Ventricle; RA= Right Atrium; RVOT = Right Ventricular Outflow Tract; PASP = Pulmonary Artery Systolic Pressure; FAC= Fractional Area Change; TAPSE= Tricuspid Annular Plane Systolic Excursion; RIMP = Right Ventricular Index of Myocardial Performance; TR = Tricuspid Regurgitation S’ = Peak Systolic Annular Velocity; RVEF = Right Ventricular Ejection Fraction; 3D = Three Dimensional Abstract Figure. Change in RVEF in 6 months

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Dual chamber pacemaker implantation during atrial fibrillation in patients with PAF

EP Europace ◽

10.1016/s1099-5129(01)80288-9 ◽

2001 ◽

Vol 2 ◽

pp. A71-A71

Keyword(s):

Atrial Fibrillation ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Dual Chamber Pacemaker

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Dislodgment of VDD Lead Connected to DR Pacer and Managed by Mode Switch

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s9625 ◽

2012 ◽

Vol 5 ◽

pp. CCRep.S9625

Author(s):

Antoine Kossaify ◽

Nayla Nicolas

Keyword(s):

Right Ventricle ◽

Clinical Settings ◽

Conservative Approach ◽

Ventricular Pacing ◽

Mode Switch ◽

Dual Chamber ◽

The Right ◽

Dependent Patient

An 80-year-old patient having a dual chamber DR pacer connected to a VDD lead presented with chronic lead dislodgment with the atrial ring displaced into the right ventricle. There was no ventricular capture at maximal ventricular output, and given the clinical settings, the condition was managed with a conservative approach, the mode was switched to AAI ensuring a minimal adequate ventricular pacing backup in a non dependent patient.

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