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Okubo Y, Sakai T, Miyamoto S, Uotani Y, Oguri N, Furutani M, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01890-z. [PMID: 39073704 DOI: 10.1007/s10840-024-01890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Although left bundle branch area pacing (LBBAP) reportedly results in fewer adverse outcomes after implantation than conventional stylet-guided right ventricular septal pacing (RVSP), previous studies have not compared LBBAP with accurate RVSP using a delivery catheter. The aim of this study was to compare clinical outcomes between LBBAP and accurate RVSP among patients with atrioventricular block (AVB). METHODS This single-center observational study enrolled 160 patients requiring RV pacing due to symptomatic AVB between September 2018 and December 2021. Primary composite outcomes included all-cause death, hospitalization due to heart failure (HF), and upgrading to biventricular pacing. Secondary composite outcomes included any procedural and postprocedural complications. RESULTS Overall, 160 patients were analyzed (LBBAP, n = 81; RVSP, n = 79). No significant differences in baseline characteristics were observed between the two groups. The RV pacing burden at 1 year after implantation was 90.8% ± 20.4% and 86.2% ± 22.6%, respectively (p = 0.21). During a mean follow-up of 840 ± 369 days, the incidence of the primary outcome was significantly lower with LBBAP (4.9%) compared to RVSP (22.8%) (Log-rank p = 0.02). There was no significant difference in the incidence of the secondary outcome between the two groups (3.7% vs. 5.1%, p = 0.65). In the multivariate analysis, baseline QRS duration, RV pacing burden, and LBBAP were independently associated with the primary outcome (baseline QRS duration: hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00-1.02; p < 0.001; RV pacing burden: HR, 1.01; 95% CI, 1.00-1.02; p < 0.001; LBBAP: HR, 0.45; 95% CI, 0.31-0.64; p < 0.001). CONCLUSION In patients requiring frequent RV pacing, LBBAP was associated with reduced adverse clinical outcome compared to accurate RVSP using a delivery catheter.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Takumi Sakai
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Motoki Furutani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Gheyath B, Khatiwala RV, Chen S, Fu Z, Beri N, English C, Bang H, Srivatsa U, Pezeshkian N, Atsina K, Fan D. Exploratory use of intraprocedural transesophageal echocardiography to guide implantation of the leadless pacemaker. Heart Rhythm O2 2022; 4:18-23. [PMID: 36713041 PMCID: PMC9877395 DOI: 10.1016/j.hroo.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Fluoroscopy is the standard tool for transvenous implantation of traditional and leadless pacemakers (LPs). LPs are used to avoid complications of conventional pacemakers, but there still is a 6.5% risk of major complications. Mid-right ventricular (RV) septal device implantation is suggested to decrease the risk, but helpful cardiac landmarks cannot be visualized under fluoroscopy. Transesophageal echocardiography (TEE) is an alternative intraprocedural imaging method. Objective The purpose of this study was to explore the spatial relationship of the LP to cardiac landmarks via TEE and their correlations with electrocardiographic (ECG) parameters, and to outline an intraprocedural method to confirm mid-RV nonapical lead positioning. Methods Fifty-six patients undergoing implantation of LP with TEE guidance were enrolled in the study. Device position was evaluated by fluoroscopy, ECG, and TEE. Distances between the device and cardiac landmarks were measured by TEE and analyzed with ECG parameters with and without RV pacing. Results Mid-RV septal positioning was achieved in all patients. TEE transgastric view (0°-40°/90°-130°) was the optimal view for visualizing device position. Mean tricuspid valve-LP distance was 4.9 ± 0.9 cm, mean pulmonary valve-LP distance was 4.2 ± 1 cm, and calculated RV apex-LP distance was 2.9 ± 1 cm. Mean LP paced QRS width was 160.8 ± 28 ms and increased from 117.2 ± 34 ms at baseline. LP RV pacing resulted in left bundle branch block pattern on ECG and 37.8% QRS widening by 43.5 ± 29 ms. Conclusion TEE may guide LP implantation in the nonapical mid-RV position. Further studies are required to establish whether this technique reduces implant complications compared with conventional fluoroscopy.
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Affiliation(s)
- Bashaer Gheyath
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Roshni Vijay Khatiwala
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Shaomin Chen
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Zhifan Fu
- Department of Geriartics, Peking University First Hospital, Beijing, China
| | - Neil Beri
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Carter English
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - Uma Srivatsa
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Nayereh Pezeshkian
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Kwame Atsina
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Dali Fan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California,Address reprint requests and correspondence: Dr Dali Fan, Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, 4680 Y St, Suite 0200, Sacramento, CA 95817.
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3
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Yoshiyama T, Shimeno K, Hayashi Y, Ito A, Iwata S, Matsumura Y, Izumiya Y, Abe Y, Ehara S, Naruko T. Risk factors of pacing-induced cardiomyopathy-Insights from lead position. J Arrhythm 2022; 38:408-415. [PMID: 35785399 PMCID: PMC9237288 DOI: 10.1002/joa3.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/20/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open
Abstract
There was no significant difference in the incidence of pacing-induced cardiomyopathy between right ventricular apex pacing group and OpenCurlyQuote;true CloseCurlyQuote; mid-right ventricular septum pacing group. The preoperative left ventricular end-systolic diameter and paced QRS duration were independent predictors of PICM.
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Affiliation(s)
- Tomotaka Yoshiyama
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Kenji Shimeno
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Yusuke Hayashi
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Asahiro Ito
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Shinichi Iwata
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | | | - Yasuhiro Izumiya
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Yukio Abe
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Shoichi Ehara
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Takahiko Naruko
- Department of CardiologyOsaka City General HospitalOsakaJapan
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4
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Tsukahara K, Oginosawa Y, Fujino Y, Keishiro Y, Miyamoto T, Yamagishi Y, Ohe H, Kohno R, Kataoka M, Abe H. Influence of the right ventricular septum/free-wall boundary (hinge) on differentiation of the ventricular lead implantation site. J Cardiol 2022; 80:332-338. [PMID: 35637122 DOI: 10.1016/j.jjcc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prognosis associated with right ventricular (RV) free-wall pacing is worse than that of septal pacing. Identification of the pacing site using a 12‑lead electrocardiogram (ECG) is controversial and may be influenced by ECG changes within the same septal or free-wall area. The relationship between the diagnostic capabilities of ECG and pacing sites has previously been qualitatively evaluated. However, in this study, this relationship was analyzed quantitatively, and accurate evaluation of the pacing site was determined using computed tomography (CT). METHODS Of 779 consecutive outpatients, 65 who underwent pacemaker implantation and thoracic CT were prospectively included and classified into the following groups according to the lead tip position: free-wall, septal, or septum/free-wall boundary (hinge) group. The hinge was used as an anatomical marker, and the distance from the hinge to the lead tip was measured. Under RV pacing, a 12‑lead ECG was obtained. ECG findings were evaluated using three criteria (including lead I, II, and aVL and precordial leads V5 and V6) previously reported to be useful in differentiating pacing sites. RESULTS The lead tips were anchored at the free-wall in 10 patients, the septal wall in 19 patients, and the hinge in 32 patients. Paced QRS duration correlated with the distance from the hinge to the lead tip for the free-wall and septum (r = 0.47 and - 0.68, respectively). Estimation of the lead tip implantation site using the ECG algorithm was useful; however, the algorithm's accuracy decreased around the hinge. CONCLUSIONS ECG is useful in differentiating pacing sites but is less accurate around the hinge, which may be the reason that the identification of the RV pacing site using ECG remains controversial.
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Affiliation(s)
- Keita Tsukahara
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Yoshihisa Fujino
- The Department of Environmental Epidemiology Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yagyu Keishiro
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taro Miyamoto
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasunobu Yamagishi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hisaharu Ohe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ritsuko Kohno
- The Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Haruhiko Abe
- The Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
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5
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Jeong HK, Kim SS, Lee KH, Yoon N, Park HW, Cho JG. Clinical outcomes in patients with atrioventricular block undergoing pacemaker: 3-year follow-up. J Interv Card Electrophysiol 2022; 64:165-172. [PMID: 35171387 DOI: 10.1007/s10840-022-01142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Left ventricular function can be affected by chronic ventricular pacing. Different right ventricular (RV) pacing sites have shown heterogeneous clinical outcomes. We investigated these factors in patients receiving permanent pacemaker (PPM) implants. METHODS This multicenter, retrospective analysis of PPM use in South Korea, included all patients undergoing de novo transvenous PPM implantation for atrioventricular block from 2017 to 2019. Clinical characteristics, 12-lead electrocardiograms, echocardiography, and laboratory parameters were evaluated. Composite outcomes are defined by two coprimary endpoints: (1) hospitalizations and (2) cardiac death by heart failure during follow-up period. RESULTS There were 167 patients (66 males; overall mean age 75.3 ± 11.9 years), divided into two groups according to the pacing site: 83 apical RV (RVA) vs. 84 septal RV (RVS). There were no significant baseline differences. Paced QRS duration (pQRSd) increased with RVA (168.5 ± 20.1 vs. 159.1 ± 16.3 ms; p < 0.001). Over a median 31-month follow-up, there were 15 hospitalizations and 2 deaths. More patients with RVA were hospitalized or died (16% vs. 5%, respectively; p = 0.049). In Cox proportional regression analysis, pQRSd (hazard ratio [HR] 1.046; 95% confidence interval [CI] 1.004-1.091; p = 0.033), and diastolic dysfunction (HR 7.343; 95% CI 2.035-26.494; p = 0.002) were independent predictors of composite clinical outcomes. CONCLUSIONS RVS placement shortened the pQRSd and improved clinical outcomes. However, the determinants of these were pQRSd and diastolic dysfunction. Therefore, clinicians should try to shorten the pQRSd when implanting a PPM, and patients with diastolic dysfunction should be monitored intensively.
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Affiliation(s)
- Hyung Ki Jeong
- Department of Cardiovascular Medicine, Wonkwang University Medical School, Iksan, Republic of Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chosun University Medical School, Donggu, Gwangju, Republic of Korea.
| | - Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
| | - Namsik Yoon
- Department of Cardiovascular Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
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6
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Shenthar J, Rai MK, Chakali SS, Pillai V, Delhaas T. Computed tomography validated right ventricular mid-septal lead implantation using right ventricular angiography. J Arrhythm 2021; 37:1131-1138. [PMID: 34621411 PMCID: PMC8485823 DOI: 10.1002/joa3.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022] Open
Abstract
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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Affiliation(s)
- Jayaprakash Shenthar
- Electrophysiology Unit Department of Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Maneesh K Rai
- Electrophysiology Unit Department of Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Siva S Chakali
- Electrophysiology Unit Department of Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Vivek Pillai
- Electrophysiology Unit Department of Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Tammo Delhaas
- Department of Biomedical Engineering Maastricht UMC+ Maastricht The Netherlands
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7
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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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8
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Yamao K, Hachiya H, Kusa S, Miwa N, Sato Y, Hara S, Ohya H, Iesaka Y, Sasano T. Individualized left anterior oblique projection based on pigtail catheter visualization facilitates leadless pacemaker implantation. J Arrhythm 2021; 37:676-682. [PMID: 34141021 PMCID: PMC8207349 DOI: 10.1002/joa3.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pacemaker positioning on the right ventricular (RV) septum during implantation is conventionally conducted utilizing two fixed fluoroscopy angles, a 45° left anterior oblique (LAO) and 35° right anterior oblique projection. However, placement location can be suboptimal, especially for leadless pacemakers (LPMs). OBJECTIVE To evaluate the safety and ease of LPM implantation using individualized LAO projection. METHODS Consecutive patients undergoing LPM implantation were prospectively included. The angle of the RV septum was recorded for each patient by studying the angle at which an RV pigtail catheter (RV-PC) could be seen edge on. This was then used as the preferred LAO projection angle for that patient. We evaluated the success rate and safety of this method. We also compared the RV septum angle as measured by this method versus that measured by chest CT. RESULTS Of the 31 patients (mean age 80.6 ± 7.0 years, 15 females), LPM implantation was successful in 30. The pacemaker was implanted on the RV septum in 29 and on the free wall in one. LPM implantation was abandoned for anatomical reasons in one. Complications were limited to a groin arteriovenous fistula and one deep vein thrombosis. The angle of RV septum as measured by pigtail catheter and chest CT was not significantly different (CT: 54.8 ± 6.0°, RV pigtail catheter: 52.9 ± 6.1°, P = .07). CONCLUSIONS Using an RV-PC to determine the preferred angle of LAO projection facilitates differentiation between the RV septum and free wall, which in turn facilitates optimal LPM placement.
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Affiliation(s)
- Kazuya Yamao
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | | | - Shigeki Kusa
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Naoyuki Miwa
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Yoshikazu Sato
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Satoshi Hara
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Hiroaki Ohya
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Yoshito Iesaka
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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9
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Naruse Y, Miyajima K, Sugiura R, Muto M, Ogano M, Kurebayashi N, Shiozawa T, Kiyama Y, Nagata E, Odagiri K, Maekawa Y. Comparison of delivery catheter-based and stylet-based right ventricular lead placement at the right ventricular septum under fluoroscopic guidance judged by cardiac CT (Mt. FUJI): a study protocol for the Mt. FUJI randomised controlled trial. BMJ Open 2021; 11:e046782. [PMID: 34039576 PMCID: PMC8160162 DOI: 10.1136/bmjopen-2020-046782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pacing-induced cardiomyopathy occasionally occurs in patients undergoing pacemaker implantation. Although compared with right ventricular (RV) apical pacing, RV septal pacing can attenuate left ventricular dyssynchrony; the success rate of lead placement on the RV septum using the stylet system is low. Additionally, no randomised controlled trial has addressed the issue regarding the accuracy of RV lead placement on the RV septum using the stylet and delivery catheter systems. This study hypothesises that a newly available delivery catheter system can improve the accuracy of RV lead placement on the RV septum. METHODS AND ANALYSIS In a multicentre, prospective, randomised, single-blind, controlled trial, 70 patients with pacemaker indication owing to atrioventricular block will be randomised to either the delivery catheter or stylet group before the pacemaker implantation procedure. The position of the RV lead tip will be assessed using ECG-gated cardiac CT in all patients within 4 weeks after pacemaker implantation. Lead tip positions are classified into three groups: (1) RV septum, (2) anterior/posterior edge of the RV septal wall and (3) RV free wall. The primary endpoint will be the success rate of RV lead tip placement on the RV septum, which will be evaluated using cardiac CT. ETHICS AND DISSEMINATION This study will be conducted according to the stipulations of the Helsinki Declaration and the institutional review board of Hamamatsu University School of Medicine. The results of the study will be disseminated at several research conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER jRCTs042200014; Pre-results.
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Affiliation(s)
- Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Ryo Sugiura
- Department of Cardiology, Seirei Hamamatsu Hospital, Hamamatsu, Japan
| | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Sunto-gun, Japan
| | | | - Tomoyuki Shiozawa
- Department of Cardiology, Juntendo Shizuoka Hospital, Izunokuni, Japan
| | - Yumi Kiyama
- Centre for Clinical Research, Hamamatsu University School of Medicine Hospital, Hamamatsu, Japan
| | - Eiko Nagata
- Centre for Clinical Research, Hamamatsu University School of Medicine Hospital, Hamamatsu, Japan
| | - Keiichi Odagiri
- Centre for Clinical Research, Hamamatsu University School of Medicine Hospital, Hamamatsu, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
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10
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Chen YL, Wang HT, Chen HC, Chai HT, Lee YW, Liu WH. Localization of right ventricular non-apical lead position: comparison of three-dimensional echocardiography, computed tomography, and fluoroscopic imaging. J Int Med Res 2021; 49:300060521996159. [PMID: 33736536 PMCID: PMC7985944 DOI: 10.1177/0300060521996159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Right ventricular (RV) septal pacing is considered a better pacing procedure compared with traditional apical pacing. This study aimed to investigate agreement among computed tomography (CT), three-dimensional echocardiography (3D-echo), and fluoroscopy for evaluating the tip of the RV pacing lead in the non-apical position in patients with permanent pacemaker implantation. METHODS Fifty-four patients were prospectively enrolled. Data on patients' characteristics and imaging findings were analyzed. The agreement rate in distinguishing the RV septal lead position among the three imaging modalities was determined. RESULTS Thirty-three (61%) patients were men and the median age was 76 years. Overall, the agreement rate among the three imaging modalities was 87% (47/54; Kappa ratio: 0.734). The agreement of 3D-echo compared with thoracic CT (Kappa ratio: 0.893) was better than that for thoracic CT and fluoroscopy (Kappa ratio: 0.658). Agreement between fluoroscopy and 3D-echo was lowest (Kappa ratio: 0.632). CONCLUSIONS Agreement in evaluating the position of the septal lead between thoracic CT and 3D-echo is better than that between other imaging modalities. Our findings indicate that 3D-echo imaging might be the best imaging tool for defining the tip of the RV non-apical lead position and be useful for guiding positioning of the RV lead.
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Affiliation(s)
- Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hui-Ting Wang
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Huang-Chung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Han-Tan Chai
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yi-Wei Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Hao Liu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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11
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Miyajima K, Urushida T, Naruse Y, Ito K, Kin F, Okazaki A, Takashima Y, Watanabe T, Kawaguchi Y, Wakabayashi Y, Maekawa Y. The usefulness of a delivery catheter system for right ventricular "true" septal pacing. Heart Vessels 2021; 36:1056-1063. [PMID: 33507356 DOI: 10.1007/s00380-021-01780-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Abstract
Right ventricular (RV) septum is an alternate site for the placement of RV lead tip instead of RV apex. Recent studies have demonstrated that less than half of the RV leads targeted for septal implantation are placed on the RV septum using a conventional stylet system; new guiding catheter systems have become available for RV lead placement. This study aimed to investigate the usefulness of the delivery catheter system in lead placement on the RV septum when compared with the stylet system. We retrospectively evaluated 198 patients who underwent fluoroscopically guided pacemaker implantation with RV leads targeted to be placed in the RV septum and in whom computed tomography was incidentally and subsequently performed. A delivery catheter was used in 16 patients, and a stylet in 182 patients. The primary endpoint of this study was the success rate of RV lead placement on the RV septum. The proportion of RV lead placement on the RV septum was higher in the delivery catheter group than in the stylet group (100% vs. 44%; p < 0.001). In the stylet group, the lead tips were placed at the hinge in 92 cases (51%) and on the free wall in 9 cases (5%). Paced QRS duration was narrower in the delivery catheter group than in the stylet group (128 ± 16 vs. 150 ± 21 ms, p < 0.01). The delivery catheter system designated for pacing leads may aid in selecting RV septal sites and achieve good physiologic ventricular activation.
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Affiliation(s)
- Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kazuki Ito
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Fumihiko Kin
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ayako Okazaki
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasuyo Takashima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Watanabe
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshitaka Kawaguchi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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12
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Cardiac anatomical axes by CT scan and confirmation of the accuracy of fluoroscopic individualized left anterior oblique projection for right ventricular lead implantation. J Interv Card Electrophysiol 2020; 60:213-219. [DOI: 10.1007/s10840-020-00729-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
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13
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Tsukahara K, Oginosawa Y, Fujino Y, Ohe H, Yamagishi Y, Iwataki M, Sonoda S, Kohno R, Otsuji Y, Abe H. Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study. J Cardiovasc Electrophysiol 2019; 30:2944-2949. [PMID: 31588621 DOI: 10.1111/jce.14208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION One cause of cerebral infarction during cryoballoon ablation is the entry of air into a sheath due to the use of inappropriate catheters. It is known that the left atrial pressure of patients with obstructive sleep apnea syndrome can be negative. However, the effects of catheter selection and negative pressure changes in the sheath on air intrusion are not yet well understood. The aim of this study was to evaluate how catheter selection and negative pressure changes affect air intrusion and to perform countermeasures for air intrusion. METHODS AND RESULTS This experiment used siphon principle to create negative pressure in the sheath. Noncryoablation catheters (not designed exclusively for cryoballoon ablation) and cryoballoon catheters were investigated. Catheters were inserted into the sheath and then removed. Thereafter, the amount of air in the sheath was measured. For catheters producing significantly larger amounts of air intrusion, the catheters were inserted via a long sheath in the sheath (sheath-in-sheath technique) and the same procedures were repeated. We found that the amount of air intrusion through most of the noncryoablation catheters was significantly larger than that through cryoablation catheters. An increase in the magnitude of negative pressure in the sheath resulted in a proportional increase in air intrusion, but the sheath-in-sheath technique significantly reduced air intrusion. CONCLUSION The amount of air intrusion increased when using catheters with complicated tip shapes and thin outer diameters and when the magnitude of negative pressure in the sheath increased. The sheath-in-sheath technique may be an effective countermeasure.
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Affiliation(s)
- Keita Tsukahara
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yoshihisa Fujino
- The Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Hisaharu Ohe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yasunobu Yamagishi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Mai Iwataki
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Shinjo Sonoda
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Ritsuko Kohno
- The Division of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Haruhiko Abe
- The Division of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyusyu, Japan
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14
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Squara F, Scarlatti D, Riccini P, Garret G, Moceri P, Ferrari E. Individualized Left Anterior Oblique Projection: A Highly Reliable Patient-Tailored Fluoroscopy Criterion for Right Ventricular Lead Positioning. Circ Arrhythm Electrophysiol 2019; 11:e006107. [PMID: 29925536 DOI: 10.1161/circep.117.006107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/30/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Classical fluoroscopic criteria for the documentation of septal right ventricular (RV) lead positioning have poor accuracy. We sought to evaluate the individualized left anterior oblique (LAO) projection as a novel fluoroscopy criterion. METHODS Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead positioning was assessed by fluoroscopy using posteroanterior, right anterior oblique 30° to rule out coronary sinus positioning, and LAO 40° in the classical group or individualized LAO in the individualized group. Individualized LAO was defined by the degree of LAO that allowed the perfect superposition of the RV apex (using the tip of the RV lead temporarily placed at the apex) and of the superior vena cava-inferior vena cava axis (materialized by a guidewire), hence providing a true profile view of the interventricular septum. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with true RV lead positioning using transthoracic echocardiography. RESULTS We included 100 patients, 50 in each study group. Agreement between RV lead septal/free wall positioning in transthoracic echocardiography and fluoroscopy was excellent in the individualized group (k=0.91), whereas it was poor in the classical group (k=0.35). Septal/free wall RV lead positioning was correctly identified in 48/50 (96%) patients in the individualized group versus 38/50 (76%) in the classical group (P=0.004). For septal lead positioning, fluoroscopy had 100% Se and 89.5% Sp in the individualized group versus 91.4% Se and 40% Sp in the classical group. Complications and procedural data were comparable in both groups. CONCLUSION Individualized LAO is a quick and highly reliable patient-tailored fluoroscopy projection for RV lead positioning.
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Affiliation(s)
- Fabien Squara
- Service de Cardiologie, CHU de Nice, Hôpital Pasteur, France.
| | | | | | - Gauthier Garret
- Service de Cardiologie, CHU de Nice, Hôpital Pasteur, France
| | - Pamela Moceri
- Service de Cardiologie, CHU de Nice, Hôpital Pasteur, France
| | - Emile Ferrari
- Service de Cardiologie, CHU de Nice, Hôpital Pasteur, France
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15
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van Zyl M, Witt CM, Bhatia S, Khasawneh M, Gaba P, Lenz CJ, Rosenbaum AN, Aung H, Hodge DO, McLeod CJ, Asirvatham SJ. Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation. Indian Pacing Electrophysiol J 2019; 19:40-46. [PMID: 30858056 PMCID: PMC6450823 DOI: 10.1016/j.ipej.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prognostic significance of paced QRS complex morphology on surface ECG remains unclear. This study aimed to assess long-term outcomes associated with variations in the paced QRS complex. METHODS Adult patients who underwent dual-chamber pacemaker implantation with 20% or more ventricular pacing and a 12-lead ECG showing a paced complex were included. The paced QRS was analyzed in leads I and aVL. Long-term clinical and echocardiographic outcomes were compared at 5 years. RESULTS The study included 844 patients (43.1% female; age 75.0 ± 12.1). Patients with a longer paced QRS (pQRS) duration in lead I had a lower rate of atrial fibrillation (HR 0.80; p = 0.03) and higher rate of systolic dysfunction (HR 1.17; p < 0.001). Total pacing complex (TPC) duration was linked to higher rates of ICD implantation (HR 1.18; p = 0.04) and systolic dysfunction (HR 1.22, p < 0.001). Longer paced intrinsicoid deflection (pID) was associated with less atrial fibrillation (HR 0.75; p = 0.01), more systolic dysfunction (HR 1.17; p < 0.001), ICD implantation (HR 1.23; p = 0.04), and CRT upgrade (HR 1.23; p = 0.03). Exceeding thresholds for TPC, pQRS, and pID of 170, 146, and 112 ms in lead I, respectively, was associated with a substantial increase in systolic dysfunction over 5 years (p < 0.001). CONCLUSIONS Longer durations of all tested parameters in lead I were associated with increased rates of left ventricular systolic dysfunction. ICD implantation and CRT upgrade were also linked to increased TPC and pID durations. Paradoxically, patients with longer pID and pQRS had less incident atrial fibrillation.
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Affiliation(s)
- Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Majd Khasawneh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prakriti Gaba
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Charles J Lenz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Htin Aung
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
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16
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Hattori M, Naruse Y, Oginosawa Y, Matsue Y, Hanaki Y, Kowase S, Kurosaki K, Mizukami A, Kohno R, Abe H, Aonuma K, Nogami A. Prognostic impact of lead tip position confirmed via computed tomography in patients with right ventricular septal pacing. Heart Rhythm 2019; 16:921-927. [PMID: 30633981 DOI: 10.1016/j.hrthm.2019.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although fluoroscopy-guided right ventricular (RV) lead placement in the ventricular septum is a widely performed procedure, variation in true RV lead tip position confirmed via computed tomography (CT) and its prognostic implications in patients with atrioventricular block (AVB) are not well understood. OBJECTIVE The purpose of this study was to evaluate the prognostic impact of CT-confirmed RV lead tip position. METHODS We retrospectively enrolled 228 consecutive patients (age 77 ± 10 years; 125 men) with AVB who underwent fluoroscopy-guided RV septal lead implantation and thoracic CT after pacemaker implantation. Patients were classified into septal and free-wall groups according to RV lead tip position. The primary endpoint was the composite outcome of cardiac death and heart failure hospitalization. RESULTS The RV lead tip was located at the free wall in 18 patients (8%). The primary endpoint occurred in 37 patients (16%) over median follow-up of 41 months. Electrocardiographic analysis found that R amplitude >0.53 mV in lead I was significantly predictive of free-wall pacing, with sensitivity of 70% and specificity of 77%. Multivariate Cox regression analysis demonstrated that the lead tip in the free wall (hazard ratio 2.93; 95% confidence interval 1.21-7.11; P = .018) was an independent predictor of the primary endpoint. CONCLUSION Fluoroscopy-guided RV lead placement carries potential risk of unexpected RV free-wall pacing and may increase the risk of cardiac death and heart failure-related hospitalization in patients undergoing RV septal pacing due to AVB and receiving thoracic CT for medical reasons.
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Affiliation(s)
- Masayuki Hattori
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yoshihisa Naruse
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan.
| | - Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuya Matsue
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Yuichi Hanaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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17
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Ventricular septal pacing: Optimum method to position the lead. Indian Heart J 2018; 70:713-720. [PMID: 30392512 PMCID: PMC6204444 DOI: 10.1016/j.ihj.2018.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/18/2017] [Accepted: 01/10/2018] [Indexed: 12/02/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is known for years. Several studies have revealed that adverse outcomes of RV apical pacing are directly linked to cumulative percentage of ventricular pacing. Algorithms to minimize ventricular pacing are only effective if there is good atrioventricular (AV) conduction. A need for an alternate site for ventricular pacing is evident in patients with high presumed ventricular pacing burden. Most studied alternate site for ventricular pacing is ventricular septum (outflow tract septum and mid-septum). Conventionally septal position of the ventricular pacing lead is confirmed by fluoroscopic appearance of the lead and characteristics electrocardiographic (ECG) features. However, several recent studies have challenged these fluoroscopic and ECG features as to be inadequate. So, there is need for a systematic approach for septal positioning of the ventricular lead.
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18
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Squara F, Scarlatti D, Riccini P, Garret G, Moceri P, Ferrari E. Classical fluoroscopy criteria poorly predict right ventricular lead septal positioning by comparison with echocardiography. J Interv Card Electrophysiol 2018. [PMID: 29536314 DOI: 10.1007/s10840-018-0355-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluoroscopic criteria have been described for the documentation of septal right ventricular (RV) lead positioning, but their accuracy remains questioned. METHODS AND RESULTS Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead was positioned using postero-anterior and left anterior oblique 40° incidences, and right anterior oblique 30° to rule out coronary sinus positioning when suspected. RV lead positioning using fluoroscopy was compared to true RV lead positioning as assessed by transthoracic echocardiography (TTE). Precise anatomical localizations were determined with both modalities; then, RV lead positioning was ultimately dichotomized into two simple clinically relevant categories: RV septal or RV free wall. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with TTE. We included 100 patients. On TTE, 66/100 had a septal RV lead and 34/100 had a free wall RV lead. Fluoroscopy had moderate agreement with TTE for precise anatomical localization of RV lead (k = 0.53), and poor agreement for septal/free wall localization (k = 0.36). For predicting septal RV lead positioning, classical fluoroscopy criteria had a high sensitivity (95.5%; 63/66 patients having a septal RV lead on TTE were correctly identified by fluoroscopy) but a very low specificity (35.3%; only 12/34 patients having a free wall RV lead on TTE were correctly identified by fluoroscopy). CONCLUSION Classical fluoroscopy criteria have a poor accuracy for identifying RV free wall leads, which are most of the time misclassified as septal. This raises important concerns about the efficacy and safety of RV lead positioning using classical fluoroscopy criteria.
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Affiliation(s)
- Fabien Squara
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France.
| | - Didier Scarlatti
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Philippe Riccini
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Gauthier Garret
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Pamela Moceri
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Emile Ferrari
- CHU de Nice, Hôpital Pasteur, Service de Cardiologie, 30 Avenue de la Voie Romaine, CS 51069, 06001, Nice Cedex 1, France
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Barold SS, Pang BJ, Mond HG. Beware of the coronary arteries with implantable cardiac electronic devices. Herzschrittmacherther Elektrophysiol 2017; 28:317-319. [PMID: 28819689 DOI: 10.1007/s00399-017-0518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The transvenous implantation of cardiac devices may sometimes cause serious complications involving the coronary arteries. The left anterior descending artery may be injured during nonapical right ventricular implantation while a right atrial lead may injure the right or circumflex coronary artery. Injury of a left internal mammary graft to a coronary artery may cause myocardial infarction.
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Affiliation(s)
- S Serge Barold
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Benjamin J Pang
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Harry G Mond
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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