Alternate Site Right Ventricular Pacing: Defining Template Scoring

Mond, Harry G.; Feldman, Alexander; Kumar, Saurabh; Rosso, Raphaël; Hung, Thuy To; Pang, B.

doi:10.1111/j.1540-8159.2011.03129.x

Cited by 17 publications

(18 citation statements)

References 19 publications

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“…The orientation of the RV lead in the LAO40 is the most frequently used criterion for placement in the mid-septum [1]. Recently this criterion has been questioned due to its inability to identify the correct mid-septal location of the lead tip.…”

Section: Discussionmentioning

confidence: 99%

“…An RV lead in the 40º left anterior oblique (LAO40) fluoroscopic view should have a typical orientation, i.e. it should be facing the spine with the angle between the horizontal plane and the lead being between 0 and 60º [1]. We have recently shown that many leads, which fulfill these LAO40 criteria, are in fact anchored outside the septum, either in the anterior wall or anteroseptal groove [2].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Close Proximity of Left Anterior Descending Artery to the Right Ventricular Lead Apparently Implanted into the Mid-septum

Osmančík

2014

Indian Pacing and Electrophysiology Journal

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Right ventricular (RV) mid-septal pacing should have fewer negative effects on left ventricular function compared to apical pacing. However, targeting the mid-septum may be technically challenging since it is usually done with two-dimensional fluoroscopy. The rotation of the heart and various shapes of the RV make it difficult to assess, whether the lead is really anchored in the septum. Many leads, apparently anchored in the septum, are in fact anchored in the anterior wall or anteroseptal groove, and some can get anchored in close proximity to the left anterior descending artery (LAD). We report three cases from our series of 51 patients, in whom the RV lead thought to be implanted in the mid-septum was in fact anchored in close proximity of LAD when assessed using computed tomography.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Close Proximity of Left Anterior Descending Artery to the Right Ventricular Lead Apparently Implanted into the Mid-septum

Osmančík

2014

Indian Pacing and Electrophysiology Journal

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“…However, the absolute majority of them considered septal position if the lead fulfilled a characteristic shape in the LAO40, which was in most studies, the only verification of septal position. 6,7 The exact location of the RV lead using more precious anatomic methods has only been verified in a few recent studies (all by echocardiography).…”

Section: Discussionmentioning

confidence: 99%

“…The main goal of implantation was to ensure midseptal pacing on the basis of currently accepted standards. 7,11 The LAO40 view was retained as the key criterion for septal placement in our study. After this position was achieved, a standard measurement of the amplitude of the QRS complex and threshold were carried out.…”

Section: Implantation Proceduresmentioning

confidence: 99%

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The Insufficiency of Left Anterior Oblique and the Usefulness of Right Anterior Oblique Projection for Correct Localization of a Computed Tomography–Verified Right Ventricular Lead Into the Midseptum

Osmančík

Štros

Heřman

et al. 2013

Circ: Arrhythmia and Electrophysiology

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spine with angle between the horizontal plane and the lead between 0° and 60°. 7 The other is the characteristic ECG pattern (ie, especially negative QRS complexes in lead I; the presence of q wave in lead I). All studies (randomized or nonrandomized), which studied RV apical versus RV nonapical pacing, have used one of these criteria for assessment of the correct location of the lead in the septal part of the RV. However, the interventricular septum is not visible on fluoroscopy. The rotation of the heart and various shapes of the RV makes it difficult to assess the correct anchor point for the RV lead. Therefore, targeting the midseptum may be technically challenging because it is based mainly on fluoroscopy and the question remains, even if it fulfills fluoroscopic or ECG criteria, whether the lead is really anchored in the septum. Very recently, some reports have been published, which questioned the LAO criterion. Original ArticleBackground-The aim of the study was to verify the correct anchoring location for the tip of the right ventricular lead using cardiac computed tomography and to assess the best fluoroscopic and ECG criteria associated with the correct location of the electrode into the midseptum. Methods and Results-Patients indicated to pacemaker implantation were prospectively enrolled. The right ventricular lead was implanted into the midseptum according to standard criteria in left anterior oblique 40 view. The cardiac shadow on the right anterior oblique 30 was divided into 4 quadrants perpendicular to the lateral cardiac silhouette and the position of the lead tip was analyzed. The exact position of the lead tip was assessed using computed tomography. Of 51 patients, the right ventricular lead was anchored midseptum in 21 (41.2%; MS group). In 30 patients (58.8%; non-MS group), the lead was anchored in the adjacent anterior wall. The angle between the lead and horizontal axis on the left anterior oblique was similar in both groups. The non-MS group was associated with shorter distances between the tip and the cardiac contours in the right anterior oblique 30 (96.7% of leads in the non-MS group were in the outer quadrant versus 9.6% in the MS group; P<0.001). The presence of the lead in the middle or inferior quadrants was independently associated with correct midseptum placement with positive predictive value of 94.7%. Conclusions-Despite

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Computed tomography validated right ventricular mid‐septal lead implantation using right ventricular angiography

Shenthar

Maneesh

Chakali

et al. 2021

Journal of Arrhythmia

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Background Right ventricular (RV) mid‐septal pacing has been proposed as an alternative to RV apical pacing. Fluoroscopic and electrocardiogram criteria are unreliable for predicting the RV mid‐septal lead position. This study aimed to define the optimal RV mid‐septal pacing site using RV angiography. Methods We randomized patients undergoing pacemaker implantation (PPM) to the RV angiography‐guided group (Group A) or conventional fluoroscopy‐guided group (Group F). In Group A, we performed an angiogram in right anterior oblique (RAO 30°), left anterior oblique (LAO 40°), and left lateral (LL) views. We made a 5‐segment grid in RAO 30° and LL views and a 3‐segment grid in LAO 40° on the angiographic silhouette to define the lead position. Computed tomography (CT) was used to validate the lead tip position in both groups. Results We enrolled 53 patients (Group A: 26, Group F: 27) with a mean age of 55.9 ± 12.2 years. CT images validated the lead position in the mid‐septum (Group A, 23 [88.5%]; Group F, 11 [40.7%], P = .0003) and anteroseptal (Group A, 3 [11.5%]; Group F, 5 [18.5%], P = .24). In Group F, the lead was in the anterior wall in 9 patients (33.3%) and the right ventricular outflow tract in 2 (7.4%) patients and none in these two positions in Group A. The lead tip in segment one on the angiographic 5‐segment grid in RAO 30° and LL views indicated a mid‐septal lead position on CT. Conclusions RV angiography is safe and may be used to confirm the mid‐septal lead position during PPM.

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Alternate Site Right Ventricular Pacing: Defining Template Scoring

Abstract: This study shows that the angle of lead attachment in the RV is altered by introducing more lead, but in most cases, the template score remains the same. Further studies are required to determine the accuracy and efficacy of the templates.

Cited by 17 publications

References 19 publications

Close Proximity of Left Anterior Descending Artery to the Right Ventricular Lead Apparently Implanted into the Mid-septum

Close Proximity of Left Anterior Descending Artery to the Right Ventricular Lead Apparently Implanted into the Mid-septum

The Insufficiency of Left Anterior Oblique and the Usefulness of Right Anterior Oblique Projection for Correct Localization of a Computed Tomography–Verified Right Ventricular Lead Into the Midseptum

Computed tomography validated right ventricular mid‐septal lead implantation using right ventricular angiography

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