Implantation of a dual-chamber permanent pacemaker in a pregnant patient guided by intracardiac echocardiography and electroanatomic mapping Kelvin C.M.

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Presentation transcript:

Implantation of a dual-chamber permanent pacemaker in a pregnant patient guided by intracardiac echocardiography and electroanatomic mapping Kelvin C.M. Chua, MBBS, Eric T.S. Lim, MBBS, Daniel T.T. Chong, MBBS, Boon Yew Tan, MBBS, Kah Leng Ho, MBBS, Chi Keong Ching, MBBS, FHRS HeartRhythm Case Reports Volume 3, Issue 11, Pages 542-545 (November 2017) DOI: 10.1016/j.hrcr.2017.09.003 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Right ventricular (RV) lead placement using intracardiac echocardiography as guidance. A: The RV lead slipping into the RV outflow tract (RVOT), confirming RV access. B: The RV lead wedged in a low RVOT septal position. C: The right atrial (RA) lead wedged into the right atrial appendage. D: The RA lead with too much slack with its loop resting on the tricuspid annulus (TA). E: The RA lead with an appropriate amount of slack, with its loop well above the TA. F: An appropriate amount slack on both RA and RV leads. G: The safe removal of decapolar mapping catheter without causing any lead dislodgement. Ao = aorta; RA = right atrium; RAA = right atrial appendage; RV = right ventricle; RVOT = right ventricular outflow tract; TA = tricuspid annulus. HeartRhythm Case Reports 2017 3, 542-545DOI: (10.1016/j.hrcr.2017.09.003) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Electroanatomic map with a right anterior oblique and left anterior oblique projection of the cardiac chambers, and B: anteroposterior fluoroscopy of the cardiac silhouette showing appropriate positions of the right atrial and right ventricular leads with extended lead helices. IVC = inferior vena cava; RA = right atrium; RAA = right atrial appendage; RV = right ventricle; RVOT = right ventricular outflow tract; SVC = superior vena cava. HeartRhythm Case Reports 2017 3, 542-545DOI: (10.1016/j.hrcr.2017.09.003) Copyright © 2017 Heart Rhythm Society Terms and Conditions