Right atrial appendage pacing: radiographic considerations

Hertzberg, BS; Chiles, Christopher D.; Ravin, CE

doi:10.2214/ajr.145.1.31

Cited by 8 publications

(3 citation statements)

References 2 publications

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“…However, CS leads were difficult to implant and occasionally resulted in perforation of the CS. RAA pacing was therefore developed as an alternative site for CS pacing [ 27 ]. RAA pacing in SSS patients was associated with a high level of intra-atrial conduction disturbances as reflected by prolonged P-wave width and a high incidence of AF recurrences [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Right versus left atrial pacing in patients with sick sinus syndrome and paroxysmal atrial fibrillation (Riverleft study): study protocol for randomized controlled trial

Ramdjan

Does

Knops

et al. 2014

Trials

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BackgroundThe incidence of sick sinus syndrome will increase due to population ageing. Consequently, this will result in an increase in the number of pacemaker implantations. The atrial lead is usually implanted in the right atrial appendage, but this position may be ineffective for prevention of atrial fibrillation. It has been suggested that pacing distally in the coronary sinus might be more successful in preventing atrial fibrillation episodes. The aim of this trial is to study the efficacy of distal coronary sinus versus right atrial appendage pacing in preventing atrial fibrillation episodes in patients with sick sinus syndrome.Methods/DesignThis study is designed as a multicenter, randomized controlled trial. Patients with sick sinus syndrome and at least one atrial fibrillation episode of 30 seconds or more in the six months before recruitment will be eligible for participation in this study.All participants will be randomized between pacing distally in the coronary sinus and right atrial appendage. Randomization is stratified for all participating centers. Conventional dual-chamber pacemakers with advanced home monitoring functionality will be implanted. The ventricular lead will be implanted in the right ventricular apex. The first three months of the 36-month follow-up period are considered as run-in time. During the pre-randomization visit and follow-up, an interview, electrocardiogram and pacemaker assessment will be performed, prescribed antiarrhythmic medication will be reviewed and patients will be asked to complete an SF-36 questionnaire. An echocardiographic examination will be conducted in the pre-randomization phase and at the end of each follow-up year. Home monitoring will be used to send daily reports in case of atrial fibrillation episodes.DiscussionThis randomized controlled trial is the first in which home monitoring will be used to compare atrial fibrillation recurrences between pacing in the distal coronary sinus or right atrial appendage. Home monitoring gives the opportunity to accurately detect atrial fibrillation episodes and to study characteristics of atrial fibrillation episodes. Should distal coronary sinus pacing significantly diminish atrial fibrillation recurrences, this study will redefine the preferential location of an atrial lead for preventive pacing.Trial registrationCurrent Controlled Trials ISRCTN65911661, registered on 8 July 2013.

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Section: Discussionmentioning

confidence: 99%

Right versus left atrial pacing in patients with sick sinus syndrome and paroxysmal atrial fibrillation (Riverleft study): study protocol for randomized controlled trial

Ramdjan

Does

Knops

et al. 2014

Trials

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“…The right atrial (preferably within the atrial appendage) lead on the frontal CXR should terminate over the right upper heart border, with a J-shaped curve and tip-directed upward. 2 On a lateral radiograph, the lead should follow a smooth anterior curve in the midportion of the heart with its tip angled cephalad into the right atrial appendage 3 ( Figs. 2 and 3 ).…”

Section: Cardiac Devicesmentioning

confidence: 99%

Uncommon Iatrogenic Devices Seen on Chest Radiographs

Raj

Tobias

2021

Indian Journal of Radiology and Imaging

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Chest radiograph (CXR) is the most common imaging performed for both inpatients and outpatients. With advances in medicine and technology, newer devices/prosthesis are being used in the treatment of cardiothoracic conditions. Some of these are common while others are seen only in a handful of cases, especially in patients being treated or referred from tertiary care centers. It is important to know about these devices, their functionality, and radiographic appearances. Many of these devices also help us in understanding the clinical condition of the patient, as some are only used in unstable patients. Newer methods of life support are now available in intensive care units and these also can be seen on CXRs. In this review, we present various iatrogenic devices that we come across on a CXR and highlight important features to determine their correct placement and potential complications. The review looks at cardiac temporary and permanent pacing devices, cardiac interventional devices used to treat congenital heart disease, newer cardiac monitoring devices, and unusual surgical devices that one may come across on a CXR. We also suggest a stepwise algorithm to assess these devices on a CXR.

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“…Leads are placed in the atrial appendage terminate over the right upper heart border, with lead tips directed cephalad on frontal radiographs ( Figure 3A). On lateral films, the lead should follow a smooth anterior curve in the midportion of the heart, with its tip turning cephalad into the appendage ( Figure 3B) [11]. Atrial leads that do not curve cephalad but rather curve laterally or medially are in lateral and septal locations, respectively.…”

Section: Imaging Assessment Of the Pacemakermentioning

confidence: 99%