The implantation of pacemakers is a common interventional procedure that is usually carried out under fluoroscopic control.There is an irreducible radiation risk for both the patient and doctors performing the procedure.Three-dimensional(3D) electro-anatomical mapping(EAM) is a new technique for identifying anatomical structures of the heart that avoids any risk of radiation.We investigated the benefits and risks of implantation of pacemakers guided only by an electroanatomic navigation system compared to traditional, fluoroscopic techniques.

Twenty two patients[mean age(73±9.6) years, 40.9% were males] underwent pacemaker implantation using the EnSite, electroanatomical mapping.Twenty four patients(45.8% males, age 72±10.3 years old) undergoing traditional pacemaker implantation served as controls.The procedure indication, serum creatinine(Scr), ejection fraction(EF), total procedure time, total fluoroscopy time, pacing and sensing parameters and complications were compared between the ESM technique and fluoroscopic controls.

EAM implants resulted in significant reductions in fluoroscopy time [(104±83) s, vs. (754.2±452)s, P < 0.001]and radiation exposure [(6.79±4.46) mGy vs.(59.32±40.94) mGy, P < 0.001] compared to conventional implantation.While the procedure time was slightly longer than that in the controls [(64±12) min vs.(56±24) min, P=0.09], pacing and sensing parameters obtained at the implantation were similar in both groups.No complications were recorded during the procedure in any patient.Patients were followed up six months to one year in the outpatient clinic after implantation.No complications were seen at follow-up.Ventricular threshold and sensing amplitudes were in normal ranges.

EAM techniques avoid exposure to radiation, and, are equally effective, in experienced hands, in placing pacemakers, compared to fluoroscopy.Further studies will be necessary to investigate the scope and utility of EAM techniques.

Electro-anatomical Mapping; Pacemaker; Fluoroscopic