Proposal for a pacemaker implant technique with minimum radiation exposure

Authors

DOI:

https://doi.org/10.24207/jca.v37i1.3489

Keywords:

Pacemaker, artificial, Surgical Procedures, Operative, Radiation Dosage, Fluoroscopy

Abstract

Objective: To describe a standardized technique for implanting a pacemaker to reduce the time of surgery and radiation exposure and to demonstrate the results in a series of patients. Methods: Through descriptive and cross-sectional statistics, 109 patients undergoing dual-chamber (DDD) and single-chamber (VVI) pacemaker implantation were evaluated, using a standardized technical approach used in the cardiac surgery service of Santa Casa de Misericórdia of Ponta Grossa-PR, Brazil, from November 2016 to November 2019. Clinical aspects, implant indication, implant times, and radiation time were studied. The technique was described, and its most relevant aspects were discussed. Results: 68.81% of the pacemakers were DDD and the surgical time ranged from 11’22’’ to 34’43’’, with a median of 18’15’’. In these cases, the fluoroscopy time ranged from 34’’ to 5’10’’, with a mean of 1’42’’ and a 16.9 mGy median amount of radiation. The time to implant the VVI pacemaker ranged from 12’ to 42’, with a median of 17’12’’. The fluoroscopy time ranged from 26’’ to 6’25’’, with a mean of 1’41’’ and the median amount of radiation was 13.6 mGy. Conclusion: The technique proved to be agile, safe, with low fluoroscopy times and small amount of radiation. There were no postoperative complications. However, few studies were found for comparison.

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References

Aquilina O. A brief history of cardiac pacing. Images in Paediatric Cardiology. 2006 [cited 2021 Mar 20];8(2):17–81. Available from: https://pubmed.ncbi.nlm.nih.gov/22368662/

Sibulko V, Iliev I, Jekova I. A Review on Pacemakers: Device Types, Operating Modes and Pacing Pulses. Problems Related to the Pacing Pulses Detection. International Professional CommunicationJournal. 2014 Jun 30;18(2):89–100. Available from: https://www.researchgate.net/publication/284181619

Ramos G, Ramos FJ, Rassi JA, Pereira E, Gabriel NS, Chaves E. Artificial cardiac pacemaker: pre and perioperative considerations . Rev. Bras. Anesthesio. 2003 [2021 Mar 20]; 53(6):854-862. Available from: https://pubmed.ncbi.nlm.nih.gov/19471703/ DOI: https://doi.org/10.1590/S0034-70942003000600015

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European Heart Journal. 2013; 34: 2281-2329. https://doi.org/10.1093/eurheartj/eht150 DOI: https://doi.org/10.15829/1560-4071-2014-4-5-63

Bronchtein S. Implante de marcapasso cardíaco definitivo. Aspectos cirúrgicos. Rev.SOCERJ. 2002;15(2): 102-112. Available from: http://sociedades.cardiol.br/socerj/revista/2002_02/a2002_v15_n02_art07.pdf

De Melo CS. Treaty of Artificial Cardiac Pacing. 5th Ed. My Publisher: Barueri, São Paulo. 2015.

Costa R, Mond GH. Levantamento Mundial da Estimulação Cardíaca Artificial no Ano de 2001. J. Cardiac Arrhythmias, 2003;16(4):228-239. Available from: https://jca.emnuvens.com.br/jca/article/view/2899

Pachón MJC, Mosquerá JA, Pachón MJC, Vargas RNA, Campos Neto CM, Costa ARB. Aspectos Epidemiológicos da Estimulação Cardíaca no Brasil – 12° ano do RBM – Registro Brasileiro de Marcapassos, Desfibriladores e Ressincronizadores Cardíacos. J Cardiac Arrhythmias. 2008; 21(1):5-12. Available from: https://jca.emnuvens.com.br/jca/article/view/2738

Souza E de, Soares JP de M. Correlações técnicas e ocupacionais da radiologia intervencionista. Jornal Vascular Brasileiro. 2008 Dec;7(4):341–50. http://doi.org/10.1590/S1677-54492008000400009 DOI: https://doi.org/10.1590/S1677-54492008000400009

Parizoti A, Guilardi Netto T. Estudo de otimização de imagens em fluoroscopia. Radiol Bras. 2009;42(6):375-378. https://doi.org/10.1590/S0100-39842009000600011 DOI: https://doi.org/10.1590/S0100-39842009000600011

Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog ., 2012;59(2):90-101; quiz 102-3. https://doi.org/10.2344/0003-3006-59.2.90 DOI: https://doi.org/10.2344/0003-3006-59.2.90

Iared W, Shigueoka DC. Exposição à radiação durante exames de imagem: dúvidas frequentes. São Paulo School of Medicine, diagnos treats. 2010;15(3): 143-145. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-567233

Bonato CC, Elnecave RH. lterações tireoidianas associadas à radiação externa em crianças e adolescentes. Arq Brazil Endocrinol Metab. 2011;55(6): 359-366. https://doi.org/10.1590/S0004-27302011000600002 DOI: https://doi.org/10.1590/S0004-27302011000600002

Tsalafoutas IA, Spanodimos SG, Maniatis PN, Fournarakis GM, Koulentianos ED, Tsigas DL. Radiation doses to patients and cardiologists from permanent cardiac pacemaker implantation procedures. Pace-Pacing Clinical Electrophysiol. 2005;28(9):910–916. https://doi.org/10.1111/j.1540-8159.2005.00194.x DOI: https://doi.org/10.1111/j.1540-8159.2005.00194.x

Heidbuchel H, Wittkampf F, Vano E, Ernst S, Schilling R, Picano E, Mont L et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. EHRA Position Paper, Europace, 2014;16(7):946 -964. https://doi.org/10.1093/europace/eut409 DOI: https://doi.org/10.1093/europace/eut409

Payne J, Lo M, Paydak H, Maskoun W. Near-zero fluoroscopy implantation of dual-chamber pacemaker in pregnancy using electroanatomic mapping. HeartRhythm Case Reports, 2016;3(4):205-209. https://doi.org/10.1016/j.hrcr.2016.12.008 DOI: https://doi.org/10.1016/j.hrcr.2016.12.008

Kudo T. Present Status of Medical Radiation and Nuclear Cardiology Usage in Japan. Ann Nucl Cardiol. 2018;4(1):142–8. https://doi.org/10.17996/anc.18-00071 DOI: https://doi.org/10.17996/anc.18-00071

Kawakami T, Saito N, Yamamoto K, Wada S, Itakura D, Momma I et al. Zero-fluoroscopy ablation for cardiac arrhythmias: A singlecenter experience in Japan. J Arrhythmia. 2021;37(6):1488–96. https://doi.org/10.1002/joa3.12644 DOI: https://doi.org/10.1002/joa3.12644

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Published

2024-10-31

How to Cite

Cray da Costa, M. A., Grczczak, R. C. V., Machado, L. V. M., & de Souza, A. C. M. F. (2024). Proposal for a pacemaker implant technique with minimum radiation exposure. JOURNAL OF CARDIAC ARRHYTHMIAS, 37. https://doi.org/10.24207/jca.v37i1.3489

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Section

Cardiac Pacing

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