Study 1516: Initial experience with three-dimensional anatomical mapping during cardiac pacing lead extraction.

Objectives We assessed the feasibility of CartoSoundTM technology (Biosense Webster Inc, Diamond Bar, CA) to image the three-dimensional (3D) relationships of fibrotic binding sites between leads and the cardiovascular system during lead extraction. Background Fibrous adherences are the principal cause of permanent cardiac pacing lead failed removal and complications, and are not directly visualized by standard approach. Methods and Results Segments of real-time 2D ultrasound images were acquired using a 10-Fr 3D SoundStarTM catheter and integrated into the Carto mapping system to obtain 3D CartoSound anatomical maps of the superior vena cava, right atrium (RA), coronary sinus, right ventricle (RV), pacing leads, and fibrous tissue during lead removal. Lead extraction procedure was performed on 46 patients (38 men; mean age 73.7±10.5 years), and 90 leads (1.96 leads/patient) with a mean time from implant of 62.7±51.8 months. CartoSound was able to detect more binding sites in RA (17.4% vs. 4.3%, p=.04), and RV (43.5% vs. 21.7%, p=.04) compared to fluoroscopy. Mean fibrosis volume (mean 2.0±1.6 cm3) correlated positively with time from implant (r=.38, p<.05), and powered-sheaths use (r=.39, p<.05), and negatively with procedural success (r=-.37, p<.05). Mean CartoSound evaluation time was 4.9±2.3 min. When compared to standard approach, the CartoSound use was characterized by a significantly lower mean procedure time (99±35.5 min vs. 30.1±23.2 min, p=.001), and major complications (1.7% vs. 0%, p=.03). Conclusions Real-time 3D fibrosis assessment using CartoSound anatomical mapping is feasible during lead extraction. Its role as a complementary surveillance tool to improve procedural outcomes requires extensive validation.