Safety of mid-septal electrode placement in implantable cardioverter defibrillator recipients — Results of the SPICE (Septal Positioning of ventricular ICD Electrodes) study

Apical versus Non‐Apical Lead: Is ICD Lead Position Important for Successful Defibrillation?

“…Although not randomized, our study is by far the largest series to assess the effect of RV lead position on DSM in over 1,200 patients, one‐quarter of whom were implanted in a non‐apical position according to the implanting physician. Consistent with the above‐mentioned studies we found no signal of inadequate DSM for the non‐apical position, even though this group had a slightly reduced sensed R‐waves at implant and slightly lower reported rates of RV coil placed completely behind the tricuspid valve. It is important to note, however, that most of the non‐apical implants were of single‐coil leads where the obliged defibrillation vector is from the RV coil to the can, whereas the majority of the apical implants were of dual‐coil leads where the vectors included a spectrum of configurations.…”

“…Failure to achieve a 10 J DSM was similar in 2.8% of patients in each group. Recently, the SPICE investigators randomized 299 ICD recipients to receive the RV defibrillation lead either in a mid‐septal or apical location. High defibrillation threshold (>25 J) was found in 7 patients (5.0%) of the mid‐septal and in 3 (2.2%) patients of the apical groups (P = 0.209).…”

Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients—A Subanalysis of the Multicenter Randomized SPICE Trial

“…Patients in the midseptal group were younger (66.2 ± 9.5 years vs 69.4 ± 10.1 years, P = 0.042) and more likely to be male (80% vs 60%, P = 0.048). As previously reported, no differences with respect to RV lead-related complications were noted (12).…”

“…7 Moreover, nonapical RV lead location was associated with a worrisome increase in the risk of ventricular tachyarrhythmias. 7 The multicenter SPICE 11,12 study evaluated the safety of positioning the high-voltage implantable cardioverter-defibrillator (ICD) lead at the RV midseptum, randomized 299 ICD recipients to receive either an apical or a midseptal RV lead position, and followed these for 12 months. As 100 (33%) CRT-defibrillator (CRT-D) recipients were included in the SPICE trial, this offers an opportunity for a post hoc analysis of this patient subgroup for clinical end points.…”

Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study

“… 26 reported an identical implant success rate, based on strict electrical predefined criteria, in both groups (89.7% in the RVS group vs. 91.7% in the RVA group, P = 0.65) with no difference in the defibrillation success rate. In a similar non-CRT population, Kolb et al ., 29 however, reported a tendency towards a higher defibrillation threshold in the mid-septal group. Our study confirms the feasibility of septal ICD RV lead implantation in a CRT population.…”