- Email: [email protected]
Response to Letter: “Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies”
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Response to Letter Response to Letter: “Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies” Alejandro Velasco MD1, Victor Manuel Velasco MD2, Fernando Rosas MD2, Cihan Cevik MD3, Carlos A. Morillo MD, FRCPC, FACC, FHRS, FESC4 1Internal
Medicine Department. Texas Tech University Health Sciences Center, Lubbock, Texas. USA 2 Electrophysiology and Cardiac Stimulation Service. Fundacion Clinica Shaio, Bogota. Colombia. 3 Cardiology Department, Texas Heart Institute at St.Luke’s Episcopal Hospital, Baylor College of Medicine, Houston, Texas. USA 4 Arrhythmia Services, Hamilton Health Sciences. Mc Master University, Hamilton, Ontario. Canada. Address for Correspondence: Alejandro Velasco MD, 3601 4th street, Lubbock, Texas. USA. 79430. Email: [email protected] Key words: Electroanatomic Mapping We appreciated hearing from Dr. Cay regarding our recent published case report that demonstrates the implantation of a permanent pacemaker in a pregnant patient with Chagas disease using the NavX® electroanatomic mapping system to reduce the exposure to ionizing radiation [1]. As Dr. Cay mentions the radiation dose necessary to produce harm in a 31-week fetus is probably greater than the dose used with fluoroscopy for implanting a cardiac device. However it is known that pregnant patients that undergo procedures involving radiation have a high perception of teratogenic risk [2] and may develop increased levels of anxiety during and after the procedure. Also, the damage produced by radiation is difficult to quantify and involves loss of tissue function or deterministic effects, which are dose dependent, and stochastic effects, which are random and not dose dependent [3]. As the American College of Obstetrics and Gynecology recommends, during pregnancy the use of imaging procedures not associated with ionizing radiation should be used when appropriate [4], and we have successfully demonstrated a method to implant an atrial and a ventricular pacing lead with minimal radiation exposure in a pregnant patient. Regarding the position of the ventricular lead documented by the chest X-Ray we agree with Dr. Cay that the lead is not in the right ventricle outflow tract, the lead is located in the midseptal area of the right ventricle. References 1. Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA. Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease. Indian Pacing Electrophysiol J 2013;13:34-7. This is an open access article under the CC BY-NC-ND license.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 164-165 (2013)
Velasco A et al, “Response to: Use of Electroanatomic Mapping beyond EP Studies”
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2. Ratnapalan S, Bentur Y, Koren G. "Doctor, will that x-ray harm my unborn child?" CMAJ. 2008 Dec 2;179(12):1293-6. 3. Bentur Y. Ionizing and nonionizing radiation in pregnancy. In: Medication safety in pregnancy and breastfeeding. Philadelphia (PA): MacGraw Hill; 2007. p. 221-48. 4. ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104:647-51.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 164-165 (2013)
Response to Letter Response to Letter: “Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies” Alejandro Velasco MD1, Victor Manuel Velasco MD2, Fernando Rosas MD2, Cihan Cevik MD3, Carlos A. Morillo MD, FRCPC, FACC, FHRS, FESC4 1Internal
Medicine Department. Texas Tech University Health Sciences Center, Lubbock, Texas. USA 2 Electrophysiology and Cardiac Stimulation Service. Fundacion Clinica Shaio, Bogota. Colombia. 3 Cardiology Department, Texas Heart Institute at St.Luke’s Episcopal Hospital, Baylor College of Medicine, Houston, Texas. USA 4 Arrhythmia Services, Hamilton Health Sciences. Mc Master University, Hamilton, Ontario. Canada. Address for Correspondence: Alejandro Velasco MD, 3601 4th street, Lubbock, Texas. USA. 79430. Email: [email protected] Key words: Electroanatomic Mapping We appreciated hearing from Dr. Cay regarding our recent published case report that demonstrates the implantation of a permanent pacemaker in a pregnant patient with Chagas disease using the NavX® electroanatomic mapping system to reduce the exposure to ionizing radiation [1]. As Dr. Cay mentions the radiation dose necessary to produce harm in a 31-week fetus is probably greater than the dose used with fluoroscopy for implanting a cardiac device. However it is known that pregnant patients that undergo procedures involving radiation have a high perception of teratogenic risk [2] and may develop increased levels of anxiety during and after the procedure. Also, the damage produced by radiation is difficult to quantify and involves loss of tissue function or deterministic effects, which are dose dependent, and stochastic effects, which are random and not dose dependent [3]. As the American College of Obstetrics and Gynecology recommends, during pregnancy the use of imaging procedures not associated with ionizing radiation should be used when appropriate [4], and we have successfully demonstrated a method to implant an atrial and a ventricular pacing lead with minimal radiation exposure in a pregnant patient. Regarding the position of the ventricular lead documented by the chest X-Ray we agree with Dr. Cay that the lead is not in the right ventricle outflow tract, the lead is located in the midseptal area of the right ventricle. References 1. Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA. Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease. Indian Pacing Electrophysiol J 2013;13:34-7. This is an open access article under the CC BY-NC-ND license.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 164-165 (2013)
Velasco A et al, “Response to: Use of Electroanatomic Mapping beyond EP Studies”
165
2. Ratnapalan S, Bentur Y, Koren G. "Doctor, will that x-ray harm my unborn child?" CMAJ. 2008 Dec 2;179(12):1293-6. 3. Bentur Y. Ionizing and nonionizing radiation in pregnancy. In: Medication safety in pregnancy and breastfeeding. Philadelphia (PA): MacGraw Hill; 2007. p. 221-48. 4. ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104:647-51.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 164-165 (2013)