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Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies
162
Letter to the Editor Use of Electroanatomic Electrophysiologic Studies
Mapping
Systems
beyond
Serkan Cay, MD Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey Address for Correspondence: Serkan Cay, MD, Yasamkent Mah. 3222. Cad., Besa Karina Evleri 2. Blok (Yakut), No: 37 D: 27 Cayyolu, 06810, Ankara, Turkey. E-mail: [email protected] Key words: Electroanatomic Mapping I have read with great interest the case presentation entitled ‘Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease’ by Velasco et al. in a recent issue of the journal [1]. The authors have presented a pregnant with Chagas disease and complete AV block requiring pacemaker implantation and treated with a DDD mode pacemaker implanted using a 3-D electroanatomic mapping system, EnSite NavX®. They have stated that pacemaker implantation using electroanatomic mapping systems can be the first choice in pregnant patients to avoid radiation exposure. Some important issues should be mentioned; first, the gestational age of the fetus of the presented female was 31 weeks. Beyond the 20th week of gestation, the fetus becomes more resistant to hazardous effects of radiation because its developmental process is completed. Therefore, the fetus gains resistance to adverse effects of radiation similar to that of a newborn. There is no absolute risk for developmental defects or miscarriage from diagnostic examinations at later stages of pregnancy. Until present, there is no data about an elevated fetal risk of congenital anomalies, intellectual disability, growth retardation, or pregnancy loss at doses of radiation exposure to the pregnant female of <50 mGy. During a radiofrequency catheter ablation, fetal exposure dose is approximately 3 mGy. [2]. All preventive measures should be taken to avoid radiation exposure for all pregnant women although there are data regarding resistance to hazardous effects of radiation. Lead or antimony aprons or shields over abdominal region can be used with short bursts of fluoroscopy as in the case. Second, the authors have stated that electroanatomic shape of the right heart including the superior vena cava, right atrium, tricuspid annulus, right ventricular apex and right ventricular outflow tract had been drawn although they have presented a limited shape. The ventricular lead was placed in the outflow tract and the atrial lead in the right atrial appendage. P-wave amplitude was good and R-wave amplitude was acceptable. Rwave amplitude could be better if the active fixation lead was tried to place in a region with a good intracardiac signal during electroanatomic mapping. Lastly, teleradiographic position of the ventricular lead obtained after delivery seems different from initial positioning. It has been located at the bottom of the right ventricle near the apex but far from the outflow tract. References 1. Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA. Utility of the NavX® This is an open access article under the CC BY-NC-ND license.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 162-163 (2013)
Cay S, “Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies” 163 Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease. Indian Pacing Electrophysiol J 2013;13:34-7. 2. 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): 162-163 (2013)
Letter to the Editor Use of Electroanatomic Electrophysiologic Studies
Mapping
Systems
beyond
Serkan Cay, MD Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey Address for Correspondence: Serkan Cay, MD, Yasamkent Mah. 3222. Cad., Besa Karina Evleri 2. Blok (Yakut), No: 37 D: 27 Cayyolu, 06810, Ankara, Turkey. E-mail: [email protected] Key words: Electroanatomic Mapping I have read with great interest the case presentation entitled ‘Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease’ by Velasco et al. in a recent issue of the journal [1]. The authors have presented a pregnant with Chagas disease and complete AV block requiring pacemaker implantation and treated with a DDD mode pacemaker implanted using a 3-D electroanatomic mapping system, EnSite NavX®. They have stated that pacemaker implantation using electroanatomic mapping systems can be the first choice in pregnant patients to avoid radiation exposure. Some important issues should be mentioned; first, the gestational age of the fetus of the presented female was 31 weeks. Beyond the 20th week of gestation, the fetus becomes more resistant to hazardous effects of radiation because its developmental process is completed. Therefore, the fetus gains resistance to adverse effects of radiation similar to that of a newborn. There is no absolute risk for developmental defects or miscarriage from diagnostic examinations at later stages of pregnancy. Until present, there is no data about an elevated fetal risk of congenital anomalies, intellectual disability, growth retardation, or pregnancy loss at doses of radiation exposure to the pregnant female of <50 mGy. During a radiofrequency catheter ablation, fetal exposure dose is approximately 3 mGy. [2]. All preventive measures should be taken to avoid radiation exposure for all pregnant women although there are data regarding resistance to hazardous effects of radiation. Lead or antimony aprons or shields over abdominal region can be used with short bursts of fluoroscopy as in the case. Second, the authors have stated that electroanatomic shape of the right heart including the superior vena cava, right atrium, tricuspid annulus, right ventricular apex and right ventricular outflow tract had been drawn although they have presented a limited shape. The ventricular lead was placed in the outflow tract and the atrial lead in the right atrial appendage. P-wave amplitude was good and R-wave amplitude was acceptable. Rwave amplitude could be better if the active fixation lead was tried to place in a region with a good intracardiac signal during electroanatomic mapping. Lastly, teleradiographic position of the ventricular lead obtained after delivery seems different from initial positioning. It has been located at the bottom of the right ventricle near the apex but far from the outflow tract. References 1. Velasco A, Velasco VM, Rosas F, Cevik C, Morillo CA. Utility of the NavX® This is an open access article under the CC BY-NC-ND license.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 13 (4): 162-163 (2013)
Cay S, “Use of Electroanatomic Mapping Systems beyond Electrophysiologic Studies” 163 Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease. Indian Pacing Electrophysiol J 2013;13:34-7. 2. 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): 162-163 (2013)