Pacing Lead Implantation Without Live Fluoroscopy: Feasibility of Acute Success in the Live Canine Model

Authors

  • INDRAJIT CHOUDHURI M.D.,

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • DAVID KRUM M.S.,

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • JOHN HARE B.S.,

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • JIM KELLEY M.S.,

    1. Medtronic Inc., Minneapolis, Minnesota, USA
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  • DAVID BECKER M.S.,

    1. Medtronic Inc., Minneapolis, Minnesota, USA
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  • M. EYMAN MORTADA M.D.,

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • MASOOD AKHTAR M.D.,

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • JASBIR SRA M.D.

    1. Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
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  • Medtronic supplied equipment used in this study.

  • Dr. Krum reports serving as a consultant for Medtronic on this project. Dr. Sra serves as a consultant and on the advisory board of Medtronic; he owns a patent relevant to registration. Mr. Becker is an employee of Medtronic Inc., with stock options in the company.

Address for correspondence: Jasbir Sra, M.D., F.A.C.C., 2801 W. Kinnickinnic River Pkwy. 777, Milwaukee, WI 53215, USA. Fax: 414-649-5769; E-mail: bdanek@hrtcare.com

Abstract

Introduction: Fluoroscopic visualization for transvenous pacing lead placement necessitates lead shielding to minimize radiation exposure. An electromagnetic (EM) navigation system that integrates real-time intracardiac tracking within an anatomic navigation environment may provide an effective alternative for lead delivery that obviates live fluoroscopy. We assessed feasibility of pacing lead implantation with electromagnetic tracking guided solely by radiographic virtual navigation and compared this to fluoroscopy-guided implants in a canine model.

Methods: Seven mongrel dogs with normal hearts were randomized to 47 pacing lead placements in the right atrium (RA) or right ventricle (RV) guided by single-plane fluoroscopy, or an experimental EM navigation system guided by registered fluoroscopic snapshots obtained before implant (EMN). Ability to achieve successful lead delivery acutely was assessed, and pacing parameters as well as fluoroscopy and implant times were measured. Means were compared using a paired t-test.

Results: All lead delivery attempts were acutely successful. One atrial lead dislodged with EMN, resulting in 46 successful pacing attempts. There was no statistical difference in pacing parameters and time for lead placement between the approaches (EMN vs fluoroscopic navigation [mean ± SD]: RA threshold 1.15 V ± 0.98 V vs 1.95 V ± 0.98 V [P = NS], RV threshold 1.18 V ± 0.58 V vs 1.42 V ± 0.63 V [P = NS], implant time 4:38 ± 2:37 minutes vs 4:44 ± 2:38 minutes [P = NS]). No live fluoroscopy was required for EMN implants.

Conclusion: Pacing lead placement with an EM system guided by preprocedural fluoroscopic views is feasible and comparable to fluoroscopic navigation, and avoids the use of live fluoroscopy.

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