Reducing Radiation Exposure during CRT Implant Procedures: Early Experience with a Sensor-Based Navigation System

作者：Thibault Bernard^*; Andrade Jason G; Dubuc Marc; Talajic Mario; Guerra Peter G; Dyrda Katia; Macle Laurent; Rivard Lena; Roy Denis; Mondesert Blandine; Khairy Paul

来源：Pacing and Clinical Electrophysiology, 2015, 38(1): 63-70.

DOI：10.1111/pace.12522

• radiation
• cardiac resynchronization therapy
• fluoroscopy

BackgroundCardiac resynchronization therapy (CRT) implant procedures are often complex and prolonged, resulting in significant ionizing radiation (IR) exposure to the patient and operator. We report our early experience working with a novel sensor-based electromagnetic tracking system (MediGuide, MDG, St. Jude Medical Inc., St. Paul, MN, USA), in terms of procedural IR exposure reduction.
Methods and ResultsInformation regarding patient demographics, procedural details, procedural duration, and IR exposure were prospectively collected on 130 consecutive CRT procedures performed between January 2013 and January 2014. Sixty procedures were performed with MDG guidance, and 70 were performed without MDG guidance. Despite a nonsignificant trend toward shorter procedure duration with the use of MDG (120 minutes vs 138 minutes with non-MDG, P = 0.088), a 66% reduction in total IR exposure (median 769 Gray<bold>m(</bold>2) vs 2,608 Gray<bold>m(</bold>2), P < 0.001) was found. This reduction was primarily driven by a >90% reduction in IR dose required to cannulate the coronary sinus (median 80 Gray<bold>m(</bold>2) vs 922 Gray<bold>m(</bold>2), P < 0.001), and to a lesser extent from a reduction in IR dose required for LV lead placement (median 330 Gray<bold>m(</bold>2) vs 737 Gray<bold>m(</bold>2), P = 0.059). In addition, a significant learning curve effect was observed with a significantly shorter procedural duration for the last 15 cases compared to the first 15 cases (median 98 minutes vs 175 minutes, P < 0.001).
ConclusionThe nonfluoroscopic MDG positioning system is associated with a dramatic reduction in exposure to IR during CRT implant procedures, with a 90% decrease in the IR dose required to cannulate the coronary sinus. A steep learning curve was quantified.

• 出版日期2015-1