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Case Reports
. 2020 May 15;11(5):4086-4089.
doi: 10.19102/icrm.2020.110502. eCollection 2020 May.

SANS FLUORO Optimized: A Case Report of Pulmonary Vein Isolation in a Patient with Cardiac Resynchronization Therapy Defibrillator and the Optimizer™ III Device

Hyacinth C Percell  1   2 , Lynn Saeger  2 , Erin Sharpe  2 , Rose Saalfeld  2 , Robert L Percell Jr  1
Affiliations
Case Reports

SANS FLUORO Optimized: A Case Report of Pulmonary Vein Isolation in a Patient with Cardiac Resynchronization Therapy Defibrillator and the Optimizer™ III Device

Hyacinth C Percell et al. J Innov Card Rhythm Manag. .

Abstract

We offer the first reported case of a pulmonary vein isolation (PVI) procedure performed in a patient with two devices, specifically a cardiac resynchronization therapy defibrillator (CRT-D) and an Optimizer™ III device (Impulse Dynamics, Mount Laurel, NJ, USA), using the SANS FLUORO technique with zero fluoroscopy. In total, this patient had six leads traversing the right atrium, including two right atrial leads, three right ventricular leads-two associated with the Optimizer™ system and one implantable cardiac defibrillator lead-and a left ventricular lead.

Keywords: Atrial fibrillation; Optimizer; congestive heart failure; implantable cardioverter-defibrillator; pulmonary vein isolation.

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Conflict of interest statement

Dr. Percell reports that he is on speaker bureaus for Abbott Medical, Biosense Webster, Janssen, Pfizer, and Boehringer Ingelheim, outside the scope of the submitted work. The other authors report no conflicts of interest for the published content. No funding was received for this work.

Figures

Figure 1:
Figure 1:
A: Several device leads in the RV as well as the long guidewire in the inferior vena cava (IVC). B: Transseptal needle with tenting. C: Transseptal sheath in the LA as well as the esophageal temperature probe.
Figure 2:
Figure 2:
Preprocedure chest radiograph revealing CRT-D and the Optimizer™ III device (Impulse Dynamics, Orangeburg, NY, USA).
Figure 3:
Figure 3:
Posterior view of the LA revealing four pulmonary veins and the left atrial appendage. Red tags are lesions with lesion size index values of more than 4.5 on the posterior wall and more than 5.0 anteriorly. White, blue, magenta, and green lesions represent impedance decreases of 5%, 10%, 15%, and 20% in ohms, respectively. Yellow points denote the His in the RA. LSPV: left superior pulmonary vein; LIPV: left inferior pulmonary vein; RSPV: right superior pulmonary vein; RIPV: right inferior pulmonary vein; LAAP: left atrial appendage.
Figure 4:
Figure 4:
Postprocedure anteroposterior chest radiograph, revealing no change occurred in lead position.
See this image and copyright information in PMC

References

    1. Percell J, Sharpe E, Percell R. SANS FLUORO (SAy No Series to FLUOROscopy). J Innov Cardiac Rhythm Manage. 2016;7(2016):2529–2534. doi: 10.19102/icrm.2016.071102. - DOI
    1. Agner E, Aguinaga L, Andersen HB, et al. Rationale and design of a study assessing treatment strategies of atrial fibrillation in patients with heart failure: the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial. Am Heart J. 2002;144(4):597–607. [CrossRef] [PubMed] - DOI - PubMed
    1. Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol. 2004;43(6):1004–1009. [CrossRef] [PubMed] - DOI - PubMed
    1. Voskoboinik A, Kalman ES, Savicky Y, et al. Reduction in radiation dose for atrial fibrillation ablation over time: a 12-year single-center experience of 2344 patients. Heart Rhythm. 2017;14(6):810–816. [CrossRef] [PubMed] - DOI - PubMed
    1. Reddy VY, Morales G, Ahmed H, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010;7(11):1644–1653. [CrossRef] [PubMed] - DOI - PubMed

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