Feasibility, accuracy, and safety of 3-dimensional electroanatomic mapping without fluoroscopy in patients with congenital heart defects

Abstract

Use of nonfluoroscopic 3-dimensional electroanatomic mapping (NF-3DEAM) in patients with congenital heart defects (CHDs) is not well reported. The purpose of this study was to evaluate the feasibility, accuracy, and safety of NF-3DEAM in patients with CHDs. Retrospective review of electrophysiologic study (EPS) in patients with CHD from 2009 to 2013 was conducted. Patients undergoing EPS with NF-3DEAM using the EnSite NavX system (St. Jude Medical) were included and those with fluoroscopy were excluded. Cardiac angiography performed in close proximity was matched with 3DEAM by proper aspect ratio using manual alignment by overlay images and comparing distances between cardiac landmarks using Pearson correlation coefficient and intraclass correlation. Success and complications were reviewed. Three-dimensional electroanatomic mapping and angiograms were compared in 48 EPS (45 patients); 13 patients with intracardiac leads, quiescent chambers indicating significant scarring, and who required transseptal puncture were excluded. Indications for EPS included documented tachyarrhythmia and preoperative mapping. Mean age was 25.3 ± 9.8 years. Simple CHDs (isolated shunt lesions or valvular lesions) were identified in 13 studies (27%) and complex CHDs (others) were identified in 35 studies (73%). Ablations were performed in 25 studies (52%). Average time to obtain right atrial geometry was 25.3 minutes (range 14-47 minutes) and right ventricular geometry was 22.8 minutes (range 12-35 minutes). Pearson correlation coefficient and intraclass correlation of cardiac landmarks were 0.90 and 0.80, respectively. Anatomic landmarks, mapping, and ablation were accurate in all 3DEAMs. No complications were recorded. NF-3DEAM is feasible, safe, and accurate in CHD patients without extensive scarring, intracardiac leads, and need for transseptal puncture.