Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT

Rowe, Matthew K.; Moore, Peter; Pratap, Jit; Coucher, John; Gould, Paul A.; Kaye, G.

doi:10.1111/pace.13066

Cited by 8 publications

(19 citation statements)

References 22 publications

(74 reference statements)

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“…In a study by Rowe et al, of 10 leads designated to be in the RV septum, seven were on the anterior RV wall, two in the anteroseptal junction, and only one was in the septum on CT scan 22 . It is now evident from studies using CT scans that conventional fluoroscopy and ECG criteria do not lead to a predictably accurate mid‐septal lead position.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…Recently, Rowe et al . 18 studied the paced ECGs of 18 patients: 8 were implanted in the apex and 10 in the septum based on fluoroscopy criteria. However, CT later revealed that only 1 of the 10 patients actually had the lead in the septum, the rest were in the adjacent anterior or free wall.…”

Section: Discussionmentioning

confidence: 99%

Can QRS morphology be used to differentiate between true septal vs. apparently septal lead placement? An analysis of ECG of real mid-septal, apparent mid-septal, and apical pacing

Malá

Osmančík

Heřman

et al. 2020

European Heart Journal Supplements

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The location of the pacemaker lead is based on the shape of the lead on fluoroscopy only, typically in the left and right anterior oblique positions. However, these fluoroscopy criteria are insufficient and many leads apparently considered to be in septum are in fact anchored in anterior wall. Periprocedural ECG could determine the correct lead location. The aim of the current analysis is to characterize ECG criteria associated with a correct position of the right ventricular (RV) lead in the mid-septum. Patients with indications for a pacemaker had the RV lead implanted in the apex (Group A) or mid-septum using the standard fluoroscopic criteria. The exact position of the RV lead was verified using computed tomography. Based on the findings, the mid-septal group was divided into two subgroups: (i) true septum, i.e. lead was found in the mid-septum, and (ii) false septum, i.e. lead was in the adjacent areas (anterior wall, anteroseptal groove). Paced ECGs were acquired from all patients and multiple criteria were analysed. Paced ECGs from 106 patients were analysed (27 in A, 36 in true septum, and 43 in false septum group). Group A had a significantly wider QRS, more left-deviated axis and later transition zone compared with the true septum and false septum groups. There were no differences in presence of q in lead I, or notching in inferior or lateral leads between the three groups. QRS patterns of true septum and false septum groups were similar with only one exception of the transition zone. In the multivariate model, the only ECG parameters associated with correct lead placement in the septum was an earlier transition zone (odds ratio (OR) 2.53, P = 0.001). ECGs can be easily used to differentiate apical pacing from septal or septum-close pacing. The only ECG characteristic that could help to identify true septum lead position was the transition zone in the precordial leads. ClinicalTrials.gov identifier: NCT02412176.

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“…However, in a recently published study Matthew Rowe et al. showed in a small number of patients that surface ECG and fluoroscopy are not predictive of right ventricular septal lead position compared to cardiac computed tomography [11].…”

Section: Discussionmentioning

confidence: 99%

Correlation of pacing site in right ventricle with paced QRS complex duration

Gupta

Parakh

Bansal

et al. 2018

Indian Pacing and Electrophysiology Journal

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Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT

Abstract: We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT.

Cited by 8 publications

References 22 publications

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

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

Can QRS morphology be used to differentiate between true septal vs. apparently septal lead placement? An analysis of ECG of real mid-septal, apparent mid-septal, and apical pacing

Correlation of pacing site in right ventricle with paced QRS complex duration

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