title: Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry.
abstract: Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry.
  
  
  
  During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ≥10 were defined as highly experienced.
  
  
  
  Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar.
  
  
  
  EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%.
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Greco
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Maines
authors.affiliation: Santa Chiara Hospital, Trento, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marini
authors.affiliation: Careggi Hospital, Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Colella
authors.affiliation: Cattinara Hospital, Trieste, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.affiliation: Cattinara Hospital, Trieste, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Vitali-Serdoz
authors.affiliation: Sant'Andrea Hospital, Vercelli, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Blandino
authors.affiliation: Sant'Andrea Hospital, Vercelli, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Barbonaglia
authors.affiliation: Civil Hospital, Conegliano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Allocca
authors.affiliation: Civil Hospital, Imperia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mureddu
authors.affiliation: Infermi Hospital, Biella, Italy.
authors.forename: Biondino
authors.initials: B
authors.lastname: Marenna
authors.affiliation: San Martino Hospital, Genova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.affiliation: Civil Hospital, Montebelluna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Vaccari
authors.affiliation: Moriggia Pelascini Hospital, Gravedona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chianca
authors.affiliation: St. Jude Medical Itsali, Agrate Brianza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Indiani
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: DI Matteo
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Angheben
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto, Italy.|Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
mesh_terms: D000200:Action Potentials; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D016022:Case-Control Studies; D017023:Coronary Angiography; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007558:Italy; D008297:Male; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012042:Registries; D012815:Signal Processing, Computer-Assisted; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: X-ray; cardiac resynchronization therapy; electroanatomic mapping; fluoroscopy; heart failure; implantable cardioverter defibrillator; pacemaker