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Septal or apical right ventricular pacing lead position - what's the optimal imaging modality - CT, MRI or 3D-echocardiography?
S248
Abstract
.. CT in identifying septal lead position. CT gave the clearest .. .. definition of lead tip position. .. Septal or apical right ventricular pacing .. .. lead position - what’s the optimal imaging .. http://dx.doi.org/10.1016/j.hlc.2015.06.323 .. modality - CT, MRI or .. .. 323 3D-echocardiography? .. .. P. Moore ∗ , C. Booth, J. Coucher, S. Ngai, T. .. Significant reduction in radiation exposure .. with a newer x-ray imaging system in the Stanton, S. Wahi, P. Gould, G. Kaye .. .. EP lab .. Princess Alexandra Hospital, Brisbane, QLD, .. .. A. Lee 1,∗ , J. Crowhurst 1 , H. Haqqani 1,2 , M. Australia .. .. Whitby 1 , R. Denman 1 . Background: Right ventricular non-apical (RVNA) pac- .. 1 . The Prince Charles Hospital, Brisbane, QLD, ing may reduce the risk of heart failure. Fluoroscopy is the ... .. Australia standard approach to determine lead tip position, but is inac- .. 2 University of Queensland, Brisbane, QLD, curate. We compared cardiac CT, MRI, transthoracic 2D and ... .. Australia 3D echocardiography (TTE) and chest x-ray (CXR) to assess .. which provides the optimal assessment of right ventricular ... .. Introduction: Radiation exposure in the EP lab can lead to lead tip position. .. . long-term morbidity for both patients and operators. Newer Methods: Eighteen patients with MRI-conditional pace- .. .. cardiovascular imaging suites allow for lower doses per makers (10 RVNA and 8 apical (RVA) leads) underwent .. contrast CT, MRI, TTE and a standard post-implant pos- ... pulse, lower frame rates and noise reduction. . Methods: We retrospectively analysed fluoroscopy times teroanterior and lateral CXR. To compare images the RV was ... .. and radiation doses (DAP) for patient procedures performed arbitrarily partitioned into three long-axis segments (right . . ventricular outflow tract, middle and apex), and two short- ... with the Philips Integris Allura H5000 (Feb 2013 – Feb 2014) . axis segments (septal and non-septal). Agreement between ... compared to those performed with the newer Siemens Artis .. Q (Feb - Nov 2014). The Siemens was set to default detector modalities was assessed. .. Results: RV lead tip position was identified in all patients ... doses of 6 nanoGy/p and frame rates of 4 fps, settings not on CT, TTE and CXR, but was not identified in 7 (39%) patients ... achievable on the older machine. . Results: Implant/EP procedures performed with the on MRI due to device-related artefact. Of 10 leads deemed to ... newer system resulted in lower radiation doses despite no . be non-apical/septal during implant, 70% were identified as .. .. differences in fluoroscopy times for complex procedures. Flunon-apical on CXR, 60% on CT, 60% on MRI and 80% on TTE. .. On CT imaging only 10% were truly septal, 20% on MRI, 30% ... oroscopy times were longer on the older system for simple .. procedures, however this alone doesn’t account for the large .. .. magnitude of dose reduction. .. .. .. Patients Fluoroscopy Times (mins) ... Radiation Dose (DAP–Gycm2 ) [median, .. Procedure (Old/New) [median, IQR] IQR] .. .. . Old New p-value Old New p-value .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360/250 5.1 (3.4-8.3) 3.4 (2.4-5.5)... <0.0001 3.0 (2.0–4.0) 0.2 (0.1-0.4) <0.0001 .. Simple Implants .. .. (PPM/ICD) .. ... Complex 46/44 18.2 (12.6–34.7) 15.2 (10.0–25.4) 0.39 24.0 (13.0–42.5) 4.5 (2.7–6.8) <0.0001 .. Implants (BiV) .. .. .. Simple RFA 198/171 19.5 (9.3–34.4) 14.0 (6.7–32.9) 0.04 9 (4–21) 1 (0.3–2.5) <0.0001 .. .. (SVT/flutter/His) .. .. Complex RFA 115/79 37.7 (28.1-48.4) 39.8 (32.3-50.9) 0.53 25.5 (14.0-41.5) 5.3 (2.4-12.4) <0.0001 .. .. (AF/VT/PVC) .. .. .. .. .. .. .. . Conclusion: Newer imaging systems allow for marked on CXR, and 80% on TTE. Agreement was better between ... .. reductions in radiation exposure during implant/EP procemodalities when assessing position of the eight designated .. .. dures with similar or lower fluoroscopy times. RVA leads. .. Conclusion: During implant leads intended for the sep- ... tum are not confirmed as such on subsequent imaging, and ... http://dx.doi.org/10.1016/j.hlc.2015.06.324 . marked heterogeneity is apparent between modalities. MRI is ... . limited by artefact, and discrepancy exists between TTE and . 322
Abstract
.. CT in identifying septal lead position. CT gave the clearest .. .. definition of lead tip position. .. Septal or apical right ventricular pacing .. .. lead position - what’s the optimal imaging .. http://dx.doi.org/10.1016/j.hlc.2015.06.323 .. modality - CT, MRI or .. .. 323 3D-echocardiography? .. .. P. Moore ∗ , C. Booth, J. Coucher, S. Ngai, T. .. Significant reduction in radiation exposure .. with a newer x-ray imaging system in the Stanton, S. Wahi, P. Gould, G. Kaye .. .. EP lab .. Princess Alexandra Hospital, Brisbane, QLD, .. .. A. Lee 1,∗ , J. Crowhurst 1 , H. Haqqani 1,2 , M. Australia .. .. Whitby 1 , R. Denman 1 . Background: Right ventricular non-apical (RVNA) pac- .. 1 . The Prince Charles Hospital, Brisbane, QLD, ing may reduce the risk of heart failure. Fluoroscopy is the ... .. Australia standard approach to determine lead tip position, but is inac- .. 2 University of Queensland, Brisbane, QLD, curate. We compared cardiac CT, MRI, transthoracic 2D and ... .. Australia 3D echocardiography (TTE) and chest x-ray (CXR) to assess .. which provides the optimal assessment of right ventricular ... .. Introduction: Radiation exposure in the EP lab can lead to lead tip position. .. . long-term morbidity for both patients and operators. Newer Methods: Eighteen patients with MRI-conditional pace- .. .. cardiovascular imaging suites allow for lower doses per makers (10 RVNA and 8 apical (RVA) leads) underwent .. contrast CT, MRI, TTE and a standard post-implant pos- ... pulse, lower frame rates and noise reduction. . Methods: We retrospectively analysed fluoroscopy times teroanterior and lateral CXR. To compare images the RV was ... .. and radiation doses (DAP) for patient procedures performed arbitrarily partitioned into three long-axis segments (right . . ventricular outflow tract, middle and apex), and two short- ... with the Philips Integris Allura H5000 (Feb 2013 – Feb 2014) . axis segments (septal and non-septal). Agreement between ... compared to those performed with the newer Siemens Artis .. Q (Feb - Nov 2014). The Siemens was set to default detector modalities was assessed. .. Results: RV lead tip position was identified in all patients ... doses of 6 nanoGy/p and frame rates of 4 fps, settings not on CT, TTE and CXR, but was not identified in 7 (39%) patients ... achievable on the older machine. . Results: Implant/EP procedures performed with the on MRI due to device-related artefact. Of 10 leads deemed to ... newer system resulted in lower radiation doses despite no . be non-apical/septal during implant, 70% were identified as .. .. differences in fluoroscopy times for complex procedures. Flunon-apical on CXR, 60% on CT, 60% on MRI and 80% on TTE. .. On CT imaging only 10% were truly septal, 20% on MRI, 30% ... oroscopy times were longer on the older system for simple .. procedures, however this alone doesn’t account for the large .. .. magnitude of dose reduction. .. .. .. Patients Fluoroscopy Times (mins) ... Radiation Dose (DAP–Gycm2 ) [median, .. Procedure (Old/New) [median, IQR] IQR] .. .. . Old New p-value Old New p-value .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360/250 5.1 (3.4-8.3) 3.4 (2.4-5.5)... <0.0001 3.0 (2.0–4.0) 0.2 (0.1-0.4) <0.0001 .. Simple Implants .. .. (PPM/ICD) .. ... Complex 46/44 18.2 (12.6–34.7) 15.2 (10.0–25.4) 0.39 24.0 (13.0–42.5) 4.5 (2.7–6.8) <0.0001 .. Implants (BiV) .. .. .. Simple RFA 198/171 19.5 (9.3–34.4) 14.0 (6.7–32.9) 0.04 9 (4–21) 1 (0.3–2.5) <0.0001 .. .. (SVT/flutter/His) .. .. Complex RFA 115/79 37.7 (28.1-48.4) 39.8 (32.3-50.9) 0.53 25.5 (14.0-41.5) 5.3 (2.4-12.4) <0.0001 .. .. (AF/VT/PVC) .. .. .. .. .. .. .. . Conclusion: Newer imaging systems allow for marked on CXR, and 80% on TTE. Agreement was better between ... .. reductions in radiation exposure during implant/EP procemodalities when assessing position of the eight designated .. .. dures with similar or lower fluoroscopy times. RVA leads. .. Conclusion: During implant leads intended for the sep- ... tum are not confirmed as such on subsequent imaging, and ... http://dx.doi.org/10.1016/j.hlc.2015.06.324 . marked heterogeneity is apparent between modalities. MRI is ... . limited by artefact, and discrepancy exists between TTE and . 322