title: Reducing radiation exposure during CRT implant procedures: early experience with a sensor-based navigation system.
abstract: BACKGROUND
  Cardiac 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.
  
  
  RESULTS
  Information 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 μGray · m(2) vs 2,608 μGray · m(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 μGray · m(2) vs 922 μGray · m(2), P < 0.001), and to a lesser extent from a reduction in IR dose required for LV lead placement (median 330 μGray·m(2) vs 737 μGray · m(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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D060733:Electromagnetic Radiation; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D011832:Radiation Injuries / Q000517:prevention & control*; D025321:Surgery, Computer-Assisted
keywords: cardiac resynchronization therapy; fluoroscopy; radiation