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Implantation of BIV ICD with Near Zero Contrast Use in Patients with Advanced Renal Insufficiency Using Three Dimensional Electro-anatomical Mapping.

Background: Biventricular (BIV) ICD implantations are traditionally performed using contrast and fluoroscopic guidance. Contrast use in patient with advanced renal disease can cause deterioration of renal function and even lead to dialysis. Objective: To evaluate the feasibility of utilizing 3 D mapping technique in reducing or eliminating contrast use in patient with advanced renal disease. Methods and Results: The study consisted of 30 consecutive adult patients, in which BIV implantation was accomplished in advanced renal disease (stage III and IV GFR 15 to 59) by EAM. Acute procedural success was 96% and only one patient LV lead implantation was unsuccessful due to unsuitable anatomy. There were no major or minor complications amongst the group. 47 % of patient had there BIV ICD implantation with zero contrast. Average contrast exposure for the group was 4.3 ml. Average ratio of contrast use to GFR (glomerular filtration rate) was only 0.1. Improved mean GFR was observed from 42 to 50 post procedure (P value<0.01), continued to improve to 48 at 3 and 6 month (P value<0.01) and improvement decreased to 45 and 44 beyond 6 month and a year (P value NS). There was no single case of contrast induced acute renal insufficiency (CI-ARI) due to minimal use of contrast. In the group an improvement of EF, NYHA class and QRS duration was also observed Conclusion: The NZC technique is safe and feasible to eliminate contrast induced acute renal insufficiency and could potentially be used for BIV ICD implantation in patients with significant renal disease.

Credits: Adel Mina, Bradley Knight, Nicholas Warnecke

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