X-ray fluoroscopy has been the primary cardiac imaging modality in permanent pacemaker implantation (PPI) operations, but it inevitably results in radiation exposure for both operators and patients. Fluoroscopy is considered a contraindication, especially in certain circumstances, such as gestation, during which the fetus is most sensitive to radiation exposure. Therefore, measures to avoid radiation exposure are necessary, and a more safe and feasible approach is needed for this procedure. Since the EnSite NavX mapping system (ENMS) can create the required geometric contours of those relevant cardiac structures and chambers, it can be used as an alternative to X-ray fluoroscopy in PPI. In addition, because the displacement of atrial leads is a common complication of PPI, lead displacement may occur more readily without fluoroscopic guidance. Therefore, reliable measures are required to prevent leads from displacement. A 41-year-old woman at the 15th week of gestation was referred to our department with recurrent episodes of syncope and amaurosis fugax for 2 years. Holter monitoring showed sinus rhythm, Mobitz Type II atrioventricular block and high-grade atrioventricular block with ventricular arrest up to 4945 ms. A dual-chamber PPI was performed successfully for the patient under the guidance of the ENMS instead of fluoroscopy. Displacement of atrial lead was effectively avoided by bending the top of atrial lead before implantation and making it a U-shape during operation, which left space for possible subsequent external pulling stress. For PPI, ENMS is a feasible and reliable alternative to traditional X-ray fluoroscopy, especially when performing operations on pregnant patients. By bending the top of the active-fixation atrial lead into a U-shape during operation, the displacement of atrial lead may be avoided.

中文翻译：

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EnSite NavX 映射系统引导在一名 41 岁的孕妇中植入双腔永久性起搏器并进行 4 年随访

X 射线透视一直是永久性起搏器植入 (PPI) 手术中的主要心脏成像方式，但它不可避免地导致操作者和患者都受到辐射照射。透视被认为是禁忌症，特别是在某些情况下，例如妊娠期，胎儿对辐射暴露最敏感。因此，避免辐射暴露的措施是必要的，并且该程序需要更安全和可行的方法。由于 EnSite NavX 映射系统 (ENMS) 可以创建这些相关心脏结构和腔室所需的几何轮廓，因此它可以用作 PPI 中 X 射线透视的替代方法。此外，由于心房导联移位是 PPI 的常见并发症，在没有透视引导的情况下，导联移位可能更容易发生。因此，需要采取可靠的措施来防止导线移位。一名 41 岁女性，孕 15 周，因晕厥和一过性黑蒙反复发作 2 年被转诊到我科。动态心电图监测显示窦性心律、Mobitz II 型房室传导阻滞和高级别房室传导阻滞，心室停搏长达 4945 毫秒。在 ENMS 指导下成功为患者进行了双腔 PPI，而不是透视。通过在植入前弯曲心房导线顶部并在操作过程中使其呈U形，有效避免心房导线移位，为后续可能的外部拉应力留出空间。对于 PPI，ENMS 是传统 X 射线透视检查的可行且可靠的替代方案，尤其是在对怀孕患者进行手术时。