Implantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic mapping system

AIMS: The aim of this study is to show the feasibility of a biventricular implantable cardioverter-defibrillator [cardiac resynchronization therapy (CRT)–ICD] implantation using an electroanatomic navigation system and a low dose of fluoroscopy. Here four case reports of patients affected by dilated cardiomyopathy, who underwent cardiac resynchronization therapy, are described. METHODS AND RESULTS: During 2010, four patients were admitted to our Cardiology Department for implantation of an CRT–ICD device in primary prevention. All had an ejection fraction of <35% and were in New York Heart Association class III despite optimal medical therapy. The implantations were performed using the EnSite NavX system. All the leads were positioned in the cardiac chambers utilizing the three-dimensional navigation system and only using X-ray to check that the leads had been positioned correctly. To our knowledge, these cases are the first use of an electroanatomic system for implantation of an CRT–ICD device and in all four cases the cannulation of the coronary sinus (CS) was performed only using the mapping system. Electroanatomic navigation made it possible to minimize X-ray exposure during the implantation of the CRT–ICD device; in addition, the mapping system was used to choose the optimum position of the CS catheter using as reference the maximum activation delay between the two ventricles. CONCLUSIONS: The NavX system shows great potential during the implantation of an CRT–ICD device. It seems to be feasible, safe, and extremely beneficial in terms of a reduction in X-ray exposure. Furthermore, there is benefit of more detailed information and accuracy during the CS lead placement.