A sensor-based electromagnetic tracking system helps to improve cardiac resynchronisation therapy (CRT) implantation facilitating speed of the procedure, reducing exposure to radiation and improving success rate of access to the coronary sinus, according to a study presented at EHRA EUROPACE – CARDIOSTIM (21–24 June, Milan, Italy).
Bernard Thibault (Institut de Cardiologie, Montreal, Canada) told delegates that the sensor-based electromagnetic tracking system (MediGuide, St Jude Medical) “performs like a GPS system that sits into your regular fluoroscopy system. It allows you to work with short fluoroscopy loops that you pre-record and provides you with a virtual biplane.” These features help the physician to reduce the duration of live X-ray during procedures, he commented.
Thibault presented the experience using MediGuide for CRT implantations at the Institut de Cardiologie in Montreal, Canada, over the last two years (2013–2015). The study is non-randomised and included 288 consecutive patients (188 were implanted with MediGuide and 100 were included in a control group). He noted that baseline characteristics were similar in both groups apart from a larger number of patients (68% vs. 58%) with left bundle branch block (LBBB) in the MediGuide group.
When using MediGuide, Thibault said “we saved about 20 to 25 minutes compared to non-MediGuide procedures”. The median procedure time reported with MediGuide was 98 minutes compared to 124 minutes in the control group, Thibault noted. In terms of time to fluoroscopy exposure, “we cut down by three quarters. The median for fluoroscopy exposure without MediGuide is 20 minutes,” he said. “We also cut down by 80% fluoroscopy dose exposure.”
Regarding procedural outcomes, the control group showed a higher percentage of failure rate (11% vs. 4%). Eight per cent of the failures in the control group were due to impossibility to get to the coronary sinus. He noted that the Institut de Cardiologie is a training centre and procedures were performed by 10 different implanters in combination with 16 different fellows. “That may explain these failures,” he noted. “The other explanation may be also that there were more patients in the control group who did not have LBBB, so maybe the implanters were less likely to pursue because the indication was less clear.”
Concluding, Thibault said, “Despite the fact that we have limited number of implant tools available for CRT implantation, with MediGuide, we can achieve quicker procedures, reduce exposure to radiation and perhaps improve success getting into the coronary sinus.”