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Wörmann J, Duncker D, Althoff T, Heeger C, Tilz R, Estner H, Rillig A, Sommer P, Iden L, Johnson V, Chun KRJ, Jansen H, Maurer T, Busch S, Steven D. [Lead placement in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2024; 35:155-164. [PMID: 38748284 PMCID: PMC11161426 DOI: 10.1007/s00399-024-01019-9] [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] [Received: 03/10/2024] [Accepted: 04/23/2024] [Indexed: 06/10/2024]
Abstract
The implantation of electrodes for cardiac implantable electronic devices (CIED) requires profound technical understanding and precise execution. The positioning of electrodes in the right ventricle and atrium has significant implications for patient safety and the effectiveness of CIED therapy. Particular focus is given to the distinction between apical and septal stimulation in ventricular positioning. Based on current data, this article provides a practice-oriented guide that leads implanters through the individual steps of electrode positioning. The implantation of electrodes for physiological stimulation (cardiac resynchronization therapy, CRT, and conduction system pacing, CSP) is not addressed in this article.
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Affiliation(s)
- Jonas Wörmann
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland.
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Till Althoff
- Klinik für Kardiologie und Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien
| | - Christian Heeger
- Department für Rhythmologie, Abteilung für Kardiologie & Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg, Deutschland
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Roland Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Philipp Sommer
- Med. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW , Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Leon Iden
- Klinik für Kardiologie , Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Victoria Johnson
- Klinik für Kardiologie und Angiologie, Universitäres Herz- und Gefäßzentrum Frankfurt, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt am Main, Deutschland
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Bremen, Deutschland
| | - Tilman Maurer
- Klinik für Innere Medizin II, Asklepios Klinik Nord - Heidberg, Hamburg, Deutschland
| | - Sonia Busch
- Abteilung für Elektrophysiologie, Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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ElRefai M, Menexi C, Abouelasaad M, Roberts P. The application of fluoroscopic criteria to define leadless pacemakers implant position and the effect of location on device performance. Br J Radiol 2023; 96:20220788. [PMID: 37171811 PMCID: PMC10546444 DOI: 10.1259/bjr.20220788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Leadless pacemakers (LPs) were designed to avoid complications associated with transvenous pacing. To minimise risk of perforations, there is preference towards implanting LPs into the septum rather than the apex or free wall.An objective yet feasible way of characterising the LP location is currently lacking. We report a simple radiological method of defining LP position and our analysis of the impact of implantation site on performance of LPs. METHODS The first 100 LPs implanted at our UK centre were reviewed and the devices' positions in fluoroscopy images and X-rays based on conventional criteria for lead positions and conventional practice for LPs positioning were assessed. The devices' electrical parameters at implant and at the latest device follow-up were used to compare performance between implantation sites. RESULTS 35.6% of implants were in the apex. 31.1% in mid-septum, 16.7% in apical septum, 15.5% on the septal right ventricular inflow and 1.1% in the septal RV outflow tract. We had no major complications.Thresholds, R-wave amplitudes, and impedance averaged at 0.67 ± 0.41 V, 10.64 ± 5.30 mV, and 777.67 ± 201.67 Ohms, respectively, at the time of implantation, and 0.66 ± 0.39 V, 14.08 ± 6.14 mV, and 564.29 ± 96.76 Ohms at the last device check. There was no difference in the pacing thresholds or impedance between implant sites. CONCLUSIONS We propose a simple, reproducible way of defining the LP location which can help standardise the assessment of the device location sites across LP implantation centres. ADVANCES IN KNOWLEDGE Emphasis on the safety and reliability of the leadless pacemakers in a real-world setting.Establishing the variation in the implantation sites for leadless pacemakers and reporting the effect of the implantation sites on the devices' performance.We propose a simple, reproducible way of defining the LP location which can help standardise the assessment of the device location sites across LP implantation centres.
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Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Christina Menexi
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Hara H, Igarashi T, Kaida T, Murakami M, Ito H, Niwano S, Ako J. Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1251-1262. [PMID: 36971867 DOI: 10.1007/s10554-023-02834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/10/2023] [Indexed: 06/09/2023]
Abstract
Evaluation of longitudinal strain (LS) from two-dimensional echocardiography is useful for global and regional left ventricular (LV) dysfunction assessment. We determined whether the LS reflects contraction process in patients with asynchronous LV activation. We studied 144 patients with an ejection fraction ≤ 35%, who had left bundle branch block (LBBB, n = 42), right ventricular apical (RVA) pacing (n = 34), LV basal- or mid-lateral pacing (n = 23), and no conduction block (Narrow-QRS, n = 45). LS distribution maps were constructed using 3 standard apical views. The times from the QRS onset-to-early systolic positive peak (Q-EPpeak) and late systolic negative peak (Q-LNpeak) were measured to determine the beginning and end of contractions in each segment. Negative strain in LBBB initially appeared in the septum and basal-lateral contracted late. In RVA and LV pacing, the contracted area enlarged centrifugally from the pacing site. Narrow-QRS showed few regional differences in strain during the systolic period. The Q-EPpeak and Q-LNpeak exhibited similar sequences characterized by septum to basal-lateral via the apical regions in LBBB, apical to basal regions in RVA pacing, and lateral to a relatively large delayed contracted area between the apical- and basal-septum in LV pacing. Differences in Q-LNpeaks between the apical and basal segments in delayed contracted wall were 107 ± 30 ms in LBBB, 133 ± 46 ms in RVA pacing, and 37 ± 20 ms in LV pacing (p < 0.05, between QRS groups). Specific LV contraction processes were demonstrated by evaluating the LS distribution and time-to-peak strain. These evaluations may have potential to estimate the activation sequence in patients with asynchronous LV activation.
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Affiliation(s)
- Hideyuki Hara
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan.
| | - Tazuru Igarashi
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Toyoji Kaida
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Masami Murakami
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Hiroshi Ito
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Atabekov TA, Khlynin MS, Mishkina AI, Batalov RE, Sazonova SI, Krivolapov SN, Saushkin VV, Varlamova YV, Zavadovsky KV, Popov SV. The Value of Left Ventricular Mechanical Dyssynchrony and Scar Burden in the Combined Assessment of Factors Associated with Cardiac Resynchronization Therapy Response in Patients with CRT-D. J Clin Med 2023; 12:jcm12062120. [PMID: 36983123 PMCID: PMC10059815 DOI: 10.3390/jcm12062120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) improves the outcome in patients with heart failure (HF). However, approximately 30% of patients are nonresponsive to CRT. The aim of this study was to determine the role of the left ventricular (LV) mechanical dyssynchrony (MD) and scar burden as predictors of CRT response. Methods: In this study, we included 56 patients with HF and the left bundle-branch block with QRS duration ≥ 150 ms who underwent CRT-D implantation. In addition to a full examination, myocardial perfusion imaging and gated blood-pool single-photon emission computed tomography were performed. Patients were grouped based on the response to CRT assessed via echocardiography (decrease in LV end-systolic volume ≥15% or/and improvement in the LV ejection fraction ≥5%). Results: In total, 45 patients (80.3%) were responders and 11 (19.7%) were nonresponders to CRT. In multivariate logistic regression, LV anterior-wall standard deviation (adjusted odds ratio (OR) 1.5275; 95% confidence interval (CI) 1.1472–2.0340; p = 0.0037), summed rest score (OR 0.7299; 95% CI 0.5627–0.9469; p = 0.0178), and HF nonischemic etiology (OR 20.1425; 95% CI 1.2719–318.9961; p = 0.0331) were the independent predictors of CRT response. Conclusion: Scar burden and MD assessed using cardiac scintigraphy are associated with response to CRT.
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Late Incidental Discovery of Compression of the Left Anterior Descending Coronary Artery by an Endocardial Defibrillator Lead. Case Rep Cardiol 2023; 2023:6646715. [PMID: 36915701 PMCID: PMC10008109 DOI: 10.1155/2023/6646715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Abstract
Coronary artery compression/damage by cardiac pacing/defibrillation leads is very rare and often an unknown complication of pacemaker implantation. Here, we present the case of a 71-year-old woman with late discovery of an asymptomatic compression of the left anterior descending (LAD) coronary artery by a defibrillation lead implanted ten years before. This dissuaded us in removing this now malfunctioning lead with high threshold, and an additional right ventricular (RV) lead was implanted along with atrial and left ventricular (LV) leads for allowing resynchronization therapy. Based on the published data, a majority of RV leads are currently implanted in the "anteroseptal area," which is neighboring the course of the LAD.
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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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Anatomy for right ventricular lead implantation. Herzschrittmacherther Elektrophysiol 2022; 33:319-326. [PMID: 35763099 PMCID: PMC9411240 DOI: 10.1007/s00399-022-00872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
AbstractTo understand the position of a pacing lead in the right ventricle and to correctly interpret fluoroscopy and intracardiac signals, good anatomical knowledge is required. The right ventricle can be separated into an inlet, an outlet, and an apical compartment. The inlet and outlet are separated by the septomarginal trabeculae, while the apex is situated below the moderator band. A lead position in the right ventricular apex is less desirable, last but not least due to the thin myocardial wall. Many leads supposed to be implanted in the apex are in fact fixed rather within the trabeculae in the inlet, which are sometimes difficult to pass. In the right ventricular outflow tract (RVOT), the free wall is easier to reach than the septal due to the fact that the RVOT wraps around the septum. A mid-septal position close to the moderator band is relatively simple to achieve and due to the vicinity of the right bundle branch may produce a narrower paced QRS complex. Special and detailed knowledge is necessary for His bundle and left bundle branch pacing.
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Narumi T, Naruse Y, Kaneko Y, Sakakibara T, Sano M, Mogi S, Suwa K, Ohtani H, Urushida T, Saotome M, Maekawa Y. Individualised left anterior oblique projection for lead implantation into interventricular septum. Open Heart 2022; 9:openhrt-2022-002009. [PMID: 35961693 PMCID: PMC9379537 DOI: 10.1136/openhrt-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Objective We sought to investigate whether it is possible to obtain individualised left anterior oblique (LAO) by preprocedural electrocardiographic parameters and, if so, whether these parameters can help to improve the success rate of right ventricular (RV) lead implantation into the interventricular septum. Methods In this observational study, we assessed the relationship between preoperative electrocardiographic parameters and the angle of the interventricular septum obtained using thoracic CT. The participants were divided into two groups: a retrospective derivation cohort to derive the optimal formula for the individual septum axis, and a prospective internal validation cohort to which we applied the optimal formula and implanted using the new method. Results In the retrospective derivation cohort (n=39), the mean angle of individualised LAO assessed by thoracic CT was 53.1°±8.9°, and the preoperative ECG QRS axis was strongly correlated with the interventricular septum axis (R2=0.490). LAO projection derived from the preoperative ECG QRS axis confirmed that the RV lead was placed in the interventricular septum during the pacemaker procedure in the prospective internal validation group (n=30). The success rate for placing the RV lead into the interventricular septum was significantly improved in the internal validation cohort (93% vs 64%, p<0.05). In addition, the N-terminal pro-brain natriuretic peptide level decreased significantly after surgery in the interventricular septal indwelling group. Conclusions Individualised LAO angle derived from the preoperative ECG QRS axis is a new useful and simple method for RV lead implantation into the interventricular septum. Trial registration number UMIN000045741.
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Affiliation(s)
- Taro Narumi
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshihisa Naruse
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yutaro Kaneko
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomoaki Sakakibara
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Makoto Sano
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Mogi
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenichiro Suwa
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hayato Ohtani
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tsuyoshi Urushida
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masao Saotome
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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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] [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
Affiliation(s)
- Tomotaka Yoshiyama
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Kenji Shimeno
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Yusuke Hayashi
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | | | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Yukio Abe
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Shoichi Ehara
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Takahiko Naruko
- Department of Cardiology Osaka City General Hospital Osaka Japan
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Shenthar J, Valappil SP, Rai MK, Banavalikar B, Padmanabhan D, Delhaas T. Angiography-guided mid/high septal implantation of ventricular leads in patients with congenital heart disease. J Arrhythm 2021; 37:1512-1521. [PMID: 34887956 PMCID: PMC8637100 DOI: 10.1002/joa3.12636] [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: 05/11/2021] [Revised: 08/22/2021] [Accepted: 09/04/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Conduction system pacing prevents pacing-induced cardiomyopathy, but it can be challenging to perform in patients with congenital heart disease (CHD), and mid/high septal lead implantation is an alternative. This study aimed to assess intraprocedural angiography's utility as a guide for mid/high-septal lead implantation in CHD patients. METHODS The study subjects were CHD patients with Class I/IIa indications for permanent pacemaker implantation. To guide septal lead implantation, we performed an intraprocedural right ventricular angiogram in anteroposterior, 40° left anterior oblique, and 30° right anterior oblique. The primary endpoint was the lead tip in the mid/high septum on computed tomography (CT). The secondary endpoints were complications and systemic ventricular function on follow-up. RESULTS From January 2008 to December 2018, we enrolled 27 patients (mean age: 30 ± 20 years; M:F 17:10) with CHD (unoperated: 20, operated: 7). The mean paced QRS duration was 131.7 ± 5.8 ms, and CT done in 22/27 patients confirmed the lead tip in the mid-septum in 16, high septum in 5, and apical septum in 1 patient. There were no procedural complications, and during a mean follow-up of 58 ± 35.2 months, there was no significant change in the systemic ventricular ejection fraction (56.4 ± 8.3% vs 53.9 + 5.9%, P = .08). Two patients with Eisenmenger syndrome died because of refractory heart failure. CONCLUSIONS Intraprocedural angiography is safe and useful to guide mid/high-septal lead implantation in CHD patients. Mid/high septal lead position preserves systemic ventricular function in patients with CHD during medium-term follow-up.
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Affiliation(s)
- Jayaprakash Shenthar
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
| | - Sanjai P. Valappil
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
| | - Maneesh K. Rai
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
| | - Bharatraj Banavalikar
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
| | - Deepak Padmanabhan
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
| | - Tammo Delhaas
- Department of Biomedical EngineeringMaastricht UMC+MaastrichtThe Netherlands
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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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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: 82] [Impact Index Per Article: 27.3] [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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Atabekov TA, Batalov RE, Sazonova SI, Krivolapov SN, Khlynin MS, Mishkina AI, Zavadovsky KV, Curnis A, Popov SV. How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease. Int J Cardiovasc Imaging 2021; 37:3323-3333. [PMID: 34100141 DOI: 10.1007/s10554-021-02308-x] [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: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
The conventional criteria for a defibrillation lead (DL) implantation don't take into account presence of scar or deep ischemia in the myocardium. This may impair a proper functioning of the DL. We sought to optimize the DL implantation placement using rest myocardial perfusion scintigraphy (MPS), which allow detecting areas of myocardial hypoperfusion (MH). To study the influence of MH and scarring, detected by MPS, on the DL parameters in patients with coronary artery disease (CAD). 69 patients (male-65, age 64.8 ± 7.7 years) with CAD and indications for ICD implantation were enrolled. Two days before ICD implantation all patients underwent MPS at rest. Then patients were divided in 2 groups. In the 1st group DL was implanted considering MPS results: to the septal position, if the most significant MH were detected in the apical segments, and to the apical position, if MH were in the septal segments. In the 2nd group DL was implanted using the conventional approach without considering MPS results. Clinical 12 months follow-up was performed with ICD interrogation. Patients of both groups were comparable by clinical and scintigraphic parameters. In the same time, in the 1st group pacing threshold was lower (p < 0.0001) and ventricle signal amplitude was higher (p < 0.0001) comparing with the 2nd group at all control points. The presence of MH detected by MPS in the area of the DL placement worsens its parameters. The results of MPS in patients with CAD can be useful for optimization of DL placement.
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Affiliation(s)
- Tariel A Atabekov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012.
| | - Roman E Batalov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Svetlana I Sazonova
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Sergey N Krivolapov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Mikhail S Khlynin
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Anna I Mishkina
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Konstantin V Zavadovsky
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Antonio Curnis
- Department of Clinical and Experimental Sciences, Università Degli Studi di Brescia, via san Faustino 74b, 25122, Brescia, Italy
| | - Sergey V Popov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
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14
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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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15
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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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16
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Corbisiero R, Mathew A, Bickert C, Muller D. Multipoint Pacing with Fusion-optimized Cardiac Resynchronization Therapy: Using It All to Narrow QRS Duration. J Innov Card Rhythm Manag 2021; 12:4355-4362. [PMID: 33520350 PMCID: PMC7834044 DOI: 10.19102/icrm.2021.120102] [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: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
Adaptive atrioventricular (AV)-shortening algorithms have achieved QRS duration (QRSd) narrowing in traditional cardiac resynchronization therapy (CRT) patients. Multipoint pacing (MPP) has also demonstrated benefit in this population. An additional site of activation via intrinsic conduction of the septum may further contribute to CRT; however, the incorporation of all strategies together has yet to be explored. We therefore developed and tested a method combining MPP-CRT and controlled septal contribution to create a multifuse pacing (MFP) technique, establishing four ventricular activation sites for CRT patients using measurements from intracardiac electrograms (EGMs) and incorporating an AV-delay shortening algorithm (SyncAV™; Abbott Laboratories, Chicago, IL, USA) to narrow the QRSd. Patients in sinus rhythm with an AV conduction time of less than 350 ms were included in this analysis and were further stratified by strictly defined left bundle branch block (sLBBB) or nonspecific intraventricular conduction delay (IVCD). EGM-based measurements to determine the QRS septal onset to right ventricular (RV) time (SRAT) and the left ventricular (LV) to RV pacing conduction time were collected and applied to a formula to facilitate MFP. QRSd was compared between before and after programming. A total of 22 patients (19 men and three women) with similar baseline characteristics were compared (all values in mean ± standard deviation). The overall baseline QRSd of 153.31 ± 24.60 ms was decreased to 115.31 ± 16.31 ms after MFP programming (p < 0.0001). The measured SRAT was 59.40 ± 28.49 ms, resulting in a negative AV offset of −20.0 ± 24.97 ms. Patients in the sLBBB group (n = 7) were aged 67.8 ± 13.3 years and had a QRSd of 168.85 ± 27.29 ms that decreased to 113 ± 16.69 ms for a reduction of 55.42 ± 19.3 ms or 32.1% (p = 0.0003). In the IVCD group (n = 15), the baseline QRSd of 146.06 ± 20.29 ms was decreased to 116 ± 16.66 ms for a reduction of 30.07 ± 16.41 ms or 20.62% (p = 0.0001). When comparing the sLBBB and IVCD groups, the sLBBB group was favored by a reduction of 25.35 ms (p = 0.00046). Ultimately, MFP achieved statistically significant reductions in QRSd in all patients tested in this analysis. The benefit was also significantly better in the sLBBB group as compared with in the IVCD group.
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17
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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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18
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Yu YJ, Chen Y, Lau CP, Liu YX, Wu MZ, Chen YY, Ho LM, Tse HF, Yiu KH. Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation. J Am Soc Echocardiogr 2020; 33:1375-1383. [DOI: 10.1016/j.echo.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023]
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19
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Hai JJ, Chan YH, Lau CP, Tse HF. Single-chamber leadless pacemaker for atrial synchronous or ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1438-1450. [PMID: 33089883 DOI: 10.1111/pace.14105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/21/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
Abstract
Leadless pacing is a major breakthrough in the management of bradyarrhythmia. Results of initial clinical trials that have demonstrated a significant reduction in acute and long-term pacing-related complications have been confirmed by real-world experience in a broader spectrum of patients. Nonetheless current use of a leadless pacemaker is hampered by its limited atrial sensing and pacing capability, as well as battery life-span and retrievability. We review the current clinical outcome data, indications and contraindications, implantation and retrieval techniques, synchronous ventricular pacing, and other clinical considerations. We also provide an overview of the latest advancements in leadless pacing technology including device-to-device communication and energy harvesting technology.
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Affiliation(s)
- Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Yap-Hang Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Shenzhen Institute of Research and Innovation, University of Hong Kong, Shenzhen, China
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20
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Mala A, Osmancik P, Herman D, Curila K, Stros P, Vesela J, Prochazkova R, Petr R. 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. Eur Heart J Suppl 2020; 22:F14-F22. [PMID: 32694949 PMCID: PMC7361669 DOI: 10.1093/eurheartj/suaa094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/13/2022]
Abstract
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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Affiliation(s)
- Anna Mala
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Jana Vesela
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Radka Prochazkova
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
| | - Robert Petr
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 100 34, Czech Republic
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21
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Left bundle branch area. A new site for physiological pacing: a pilot study. Heart Vessels 2020; 35:1563-1572. [DOI: 10.1007/s00380-020-01623-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
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22
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Kajiyama T, Kondo Y, Nakano M, Miyazawa K, Nakano M, Hayashi T, Ito R, Takahira H, Kitagawa M, Kobayashi Y. Peak deflection index as a predictor of a free-wall implantation of contemporary leadless pacemakers. J Interv Card Electrophysiol 2020; 60:239-245. [PMID: 32242303 DOI: 10.1007/s10840-020-00724-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Leadless pacemakers are an effective treatment for bradycardia. However, some cases exhibit pericardial effusions, presumably associated with device implantations on the right ventricular free-wall. The present study was carried out to find the ECG features during ventricular pacing with a Micra, which enabled distinguishing free-wall implantations from septal implantations without using imaging modalities. METHODS Thirty-one consecutive patients who received Micra implantations in our facility were enrolled. The location of the device in the right ventricle was evaluated using echocardiography or computed tomography in order to determine whether the device was implanted on the septum (Sep group), apex (Apex group), or free-wall (FW group). The differences in the 12-lead ECG during ventricular pacing by the Micra were analyzed between the Sep and FW groups. RESULTS The body of the Micra was clearly identifiable in 22 patients. The location of the device was classified into Sep in 12 patients, Apex in 4, and FW in 6. The mean age was highest in the FW and lowest in the Sep group (82.7 ± 6.6 vs. 72.8 ± 8.7 years, p = 0.027). The peak deflection index (PDI) was significantly larger in the FW group than Sep/Apex group in lead V1 (Sep: 0.505 ± 0.010, Apex: 0.402 ± 0.052, FW: 0.617 ± 0.043, p = 0.004) and lead V2 (Sep: 0.450 ± 0.066, Apex: 0.409 ± 0.037, FW: 0.521 ± 0.030, p = 0.011), whereas there was no difference in the QRS duration, transitional zone, and QRS notching. CONCLUSION The PDI in V1 could be useful for predicting implantations of Micra devices on the free-wall and may potentially stratify the risk of postprocedural pericardial effusions.
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Affiliation(s)
- Takatsugu Kajiyama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yusuke Kondo
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyo Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tomohiko Hayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Haruhiro Takahira
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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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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24
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Jessel PM, Yadava M, Nazer B, Dewland TA, Miller J, Stecker EC, Bhamidipati CM, Song HK, Henrikson CA. Transvenous management of cardiac implantable electronic device late lead perforation. J Cardiovasc Electrophysiol 2020; 31:521-528. [DOI: 10.1111/jce.14331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/28/2019] [Accepted: 12/07/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Peter M. Jessel
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
- Division of CardiologyVA Portland Health Care System Portland Oregon
| | - Mrinal Yadava
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Babak Nazer
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Thomas A. Dewland
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Jared Miller
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Eric C. Stecker
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | | | - Howard K. Song
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Charles A. Henrikson
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
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25
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Kaye G. The desire for physiological pacing: Are we there yet? J Cardiovasc Electrophysiol 2019; 30:3025-3038. [DOI: 10.1111/jce.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Gerry Kaye
- University of Queensland Medical School, Herston Brisbane Queensland Australia
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26
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Matsuo M, Shimeno K, Yoshiyama T, Matsumura Y, Matsumoto R, Abe Y, Naruko T, Yoshiyama M. Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing. J Cardiovasc Electrophysiol 2019; 30:2433-2440. [DOI: 10.1111/jce.14174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Masanori Matsuo
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Kenji Shimeno
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | | | | | - Ryo Matsumoto
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Yukio Abe
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Takahiko Naruko
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine Osaka City University Osaka Japan
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27
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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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Di Stolfo G, Mastroianno S, Massaro R, Vigna C, Russo A, Potenza DR. Inappropriate shock and percutaneous cardiac intervention: A lesson to learn in the cath lab. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1496-1498. [PMID: 31420987 DOI: 10.1111/pace.13784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/02/2019] [Accepted: 08/15/2019] [Indexed: 11/27/2022]
Abstract
Coronary disease is a common condition in patients affected by heart failure with severely reduced ejection fraction (HFrEF). This condition represents an indication for implantable cardioverter defibrillator (ICD) in order to reduce the risk of sudden death related to arrhythmias. Nevertheless, inappropriate shocks are associated with worse quality of life, hospitalization, and death. We present the case of an inappropriate shock related to percutaneous coronary intervention during the insertion and advancement of the guidewire into the left anterior descending artery (LAD) in a patient with an ICD. Physicians' awareness about the clinical implication of noise arising during a coronary procedure is very important in patients with an ICD or pacemaker, to avoid inappropriate shock or pacing inhibition and to raise the possibility of lead implantation in or helix protrusion into the coronary lumen.
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Affiliation(s)
- Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Sandra Mastroianno
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Raimondo Massaro
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Carlo Vigna
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Aldo Russo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Domenico Rosario Potenza
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
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29
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Hai JJ, Fang J, Tam CC, Wong CK, Un KC, Siu CW, Lau CP, Tse HF. Safety and feasibility of a midseptal implantation technique of a leadless pacemaker. Heart Rhythm 2019; 16:896-902. [DOI: 10.1016/j.hrthm.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 10/27/2022]
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30
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Shimeno K, Yoshiyama T, Abe Y, Akamatsu K, Kagawa S, Matsushita T, Matsuo M, Matsumura Y, Matsumoto R, Kamimori K, Naruko T, Doi A, Takagi M, Yoshiyama M. The usefulness of right ventriculography to aid anchoring a pacing lead to the right ventricular septum. Europace 2019; 20:1154-1160. [PMID: 28679175 DOI: 10.1093/europace/eux165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Although right ventricular septal pacing is thought to be more effective in minimizing pacing-induced left ventricular dysfunction, the accurate way to anchor the lead to the right ventricular septum (RVS) has not been established. Our aim was to clarify the usefulness of right ventriculography (RVG) to aid accurate anchoring of the lead to the RVS. Methods and results Eighty-four patients who underwent pacemaker implantation were enrolled. We anchored the lead to the RVS by using an RVG image obtained at a 30° right anterior oblique view as a reference. We confirmed the actual lead position by performing computed tomography after the procedure and examined the characteristics of the paced QRS complex. Of the 81 patients, except 3 patients whose leads were anchored to the apex due to high pacing thresholds in the RVS, the leads were successfully anchored to the RVS in the 79 (98%) patients, and the number of leads placed in the high-, mid-, and low-RVS was 3 (4%), 58 (73%), and 18 (23%), respectively. The paced QRS duration in these 79 patients was 140 ± 13 ms. The paced QRS duration from mid-RVS was considerably narrower than that from high- or low-RVS (137 ± 12 ms vs. 146 ± 12 ms; P = 0.012). Conclusion Right ventriculography was very useful in aiding accurate anchoring of the lead to the RVS. Further, pacing from mid-RVS may be more effective in minimizing the QRS duration than pacing from other RVS sites.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Kanako Akamatsu
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Syunsuke Kagawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Tsukasa Matsushita
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Masanori Matsuo
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Yoshiki Matsumura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Ryo Matsumoto
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Kimio Kamimori
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Atsuhi Doi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
| | - Masahiko Takagi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
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Abstract
Lead extraction procedures have a low but real risk of major complications, such as superior vena cava tear and cardiac tamponade. Complications during lead removal are commonly related to lead binding sites, lead malposition, and lead perforation. Lead extraction imaging may indicate lead vascular binding sites, lead position, and perforation. Several imaging modalities are available, including chest radiograph, cardiac computed tomography, and echocardiography. The information provided by various imaging modalities will help assess the challenges of each lead extraction procedure and allows for better preprocedure planning.
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Affiliation(s)
- Pierce J Vatterott
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA.
| | - Imran S Syed
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
| | - Akbar H Khan
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
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32
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Anatomical context of left anterior descending artery and right ventricular lead implanted apparently in the midseptal position - Case report. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Okada M, Kashiwase K, Hirata A, Takeda Y, Amiya R, Ueda Y, Higuchi Y, Yasumura Y. Clinical Influence and Predictors of Pacing-Induced Mechanical Asynchrony in Patients with Normal Cardiac Function with Ventricular Lead Placed in Non-Apical Position. Int Heart J 2018; 59:1275-1287. [PMID: 30393263 DOI: 10.1536/ihj.17-672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricular apical (RVA) pacing often causes left ventricular (LV) mechanical asynchrony, which is enhanced by impaired cardiac contraction and intrinsic conduction abnormality. However, data on patients with normal cardiac function and under RV non-apical (non-RVA) pacing are limited.We retrospectively investigated 97 consecutive patients with normal ejection fraction who received pacemaker implantation for atrioventricular block with the ventricular lead placed in a non-RVA position. We defined mechanical asynchrony as discoordinate contraction between opposing regions of the LV wall evaluated by echocardiography. Asynchrony was detected in 9 (9%) patients at baseline and in 38 (39%) under non-RVA pacing (P < 0.001). Asynchrony at baseline was significantly associated with complete left bundle branch block (CLBBB) [odds ratio (OR) = 20.8, P < 0.001]. Asynchrony under non-RVA pacing was significantly associated with left anterior fascicular block (LAFB) (OR = 7.14, P < 0.001) and CLBBB (OR = 13.3, P = 0.002) at baseline. New occurrence of asynchrony was significantly associated with LAFB at baseline (OR = 5.88, P = 0.001). During a median follow-up period of 4.8 years, the incidence of device-detected atrial fibrillation (AF) was more frequent in patients who developed asynchrony than in those who did not (53.3% versus 27.5%, hazard ratio = 2.17, 95% confidence interval = 1.02-4.61, P = 0.03).In patients with normal cardiac function, LAFB at baseline was significantly associated with new occurrence of mechanical asynchrony under non-RVA pacing. Abnormal contraction had a significant influence on the incidence of device-detected AF.
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Affiliation(s)
| | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
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34
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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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35
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González J, Aguilera L, Gutiérrez C, Delgado G, Gaxiola E. Perforación miocárdica subaguda relacionada a electrodo de marcapasos. Reporte de caso y revisión de la literatura. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:136-139. [DOI: 10.1016/j.acmx.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022] Open
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36
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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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Hayashi Y, Takagi M, Kakihara J, Sakamoto S, Tatsumi H, Doi A, Iwata S, Sugioka K, Yoshiyama M. Impact of simple electrocardiographic markers as predictors for deterioration of left ventricular function in patients with frequent right ventricular apical pacing. Heart Vessels 2017; 33:299-308. [PMID: 28952029 DOI: 10.1007/s00380-017-1052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
Several trials demonstrated that frequent right ventricular apical pacing (RVAP) was associated with cardiac dysfunction and an increased rate of heart failure hospitalization. However, there are few reports about the 12-lead electrocardiogram (12-ECG) parameters at the time of device implantation to predict deterioration of LVEF in patients with frequent RVAP. We retrospectively studied 115 consecutive patients undergoing pacemaker or implantable cardioverter-defibrillator implantation with RVAP, with rate of ventricular pacing ≥ 40% and LVEF ≥ 50% at the time of implantation. We compared the 12-ECG characteristics at the time of device implantation between patients with deterioration of LVEF (≥ 10% reduction) and those without. Twenty-nine patients (25%) had deteriorated LVEF with a decrease in mean LVEF from 59 to 40% during a median follow-up period of 8.9 [4.6-13.7] years. Multivariate logistic regression analysis showed that cumulative % of ventricular pacing [odds ratio (OR) 1.04 per 1% increase, 95% confidence interval (CI) 1.01-1.09, p = 0.04], notching of baseline paced QRS in limb leads (OR 5.04, 95% CI 1.59-19.6, p = 0.005) and the QS pattern in all precordial leads (OR 3.56, 95% CI 1.21-10.8, p = 0.02) were independently associated with deterioration of LVEF. The QS pattern of baseline paced QRS in all precordial leads had 58% sensitivity, 93% specificity for the RV lead position at the tip of RV apex. In conclusion, considering OR by multivariate analysis, notching of baseline paced QRS in limb leads and the QS pattern in all precordial leads at device implantation may be simple and useful predictors to identify patients who are at risk for deterioration of cardiac function during long-term RVAP. 12-ECG monitoring at device implantation and avoidance of the RVAP site showing a QS pattern may be important to prevent deterioration of cardiac function in patients with frequent RVAP.
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Affiliation(s)
- Yusuke Hayashi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Takagi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Jun Kakihara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shogo Sakamoto
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Tatsumi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenichi Sugioka
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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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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Kaye GC, Rowe MK, Gould PA. Using the Surface ECG to Identify Right Ventricular Pacing Lead Position: A Cautionary Tale. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1039-1041. [PMID: 28240372 DOI: 10.1111/pace.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
Chronic right ventricular (RV) apical pacing may lead to the development of heart failure in some patients. Although pacing of the RV septum has been proposed as an alternative, positioning a lead in the true septum has proven challenging. In addition to fluoroscopy at implant, it has been suggested that 12-lead surface electrocardiogram (ECG) can be used to determine septal lead position; however, studies show this may be inaccurate. We present a case where a change in the ECG QRS axis late after pacemaker insertion with an active fixation lead highlights the difficulties of ECG localization of pacing leads.
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Affiliation(s)
- Gerald C Kaye
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew K Rowe
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Paul A Gould
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Rowe MK, Moore P, Pratap J, Coucher J, Gould PA, Kaye GC. Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:537-544. [PMID: 28244206 DOI: 10.1111/pace.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/11/2017] [Accepted: 02/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12-lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG-gated multidetector contrast-enhanced computed tomography (MDCT) with the position derived from the surface 12-lead ECG. METHODS Eighteen patients with permanent RV leads were prospectively enrolled. Leads were placed in the RV septum (RVS) in 10 and the RV apex (RVA) in eight using fluoroscopy with anteroposterior and left anterior oblique 30° views. All patients underwent MDCT imaging and paced ECG analysis. ECG criteria were: QRS duration; QRS axis; positive or negative net QRS amplitude in leads I, aVL, V1, and V6; presence of notching in the inferior leads; and transition point in precordial leads at or after V4. RESULTS Of the 10 leads implanted in the RVS, computed tomography (CT) imaging revealed seven to be at the anterior RV wall, two at the anteroseptal junction, and one in the true septum. For the eight RVA leads, four were anterior, two septal, and two anteroseptal. All leads implanted in the RVS met at least one ECG criteria (median 3, range 1-6). However, no criteria were specific for septal position as judged by MDCT. Mean QRS duration was 160 ± 24 ms in the RVS group compared with 168 ± 14 ms for RVA pacing (P = 0.38). CONCLUSIONS We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT.
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Affiliation(s)
- Matthew K Rowe
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Moore
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jit Pratap
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - John Coucher
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Paul A Gould
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerald C Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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41
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Herman AR, Gardner M, Steinberg C, Yeung-Lai-Wah JA, Healey JS, Leong-Sit P, Krahn AD, Chakrabarti S. Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2016; 13:1964-70. [DOI: 10.1016/j.hrthm.2016.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Indexed: 11/26/2022]
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Moore P, Coucher J, Ngai S, Stanton T, Wahi S, Gould P, Booth C, Pratap J, Kaye G. Imaging and Right Ventricular Pacing Lead Position: A Comparison of CT, MRI, and Echocardiography. Pacing Clin Electrophysiol 2016; 39:382-92. [PMID: 26769293 DOI: 10.1111/pace.12817] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Right ventricular nonapical (RVNA) pacing may reduce the risk of heart failure. Fluoroscopy is the standard approach to determine lead tip position, but is inaccurate. We compared cardiac computed tomography (CT), magnetic resonance imaging (MRI), two-dimensional and three-dimensional transthoracic echocardiography (TTE), and chest x-ray (CXR) to assess which provides the optimal assessment of right ventricular (RV) lead tip position. METHODS Eighteen patients with MRI-conditional pacemakers (10 RVNA and eight apical [RVA] leads) underwent contrast CT, MRI, TTE, and a standard postimplant posteroanterior and lateral CXR. To compare images, the RV was arbitrarily partitioned into three long-axis segments (right ventricular outflow tract, middle, and apex), and two short-axis segments (septal and nonseptal). Agreement between modalities was assessed. RESULTS RV lead tip position was identified in all patients on CT, TTE, and CXR, but was not identified in seven (39%) patients on MRI due to device-related artifact. Of 10 leads deemed to be nonapical/septal during implant, 70% were identified as nonapical on CXR, 60% on CT, 60% on MRI, and 80% on TTE. On CT imaging only 10% were truly septal, 20% on MRI, 30% on CXR, and 80% on TTE. Agreement was better between modalities when assessing position of the designated RVA leads. CONCLUSION During implant leads intended for the septum are not confirmed as such on subsequent imaging, and marked heterogeneity is apparent between modalities. MRI is limited by artifact, and discrepancy exists between TTE and CT in identifying septal lead position. CT gave the clearest definition of lead tip position.
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Affiliation(s)
- Peter Moore
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - John Coucher
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stanley Ngai
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tony Stanton
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sudhir Wahi
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Gould
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Cameron Booth
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jit Pratap
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gerald Kaye
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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43
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Chen D, Wei H, Tang J, Liu L, Wu S, Lin C, Zhang Q, Liang Y, Chen S. A randomized comparison of fluoroscopic techniques for implanting pacemaker lead on the right ventricular outflow tract septum. Int J Cardiovasc Imaging 2016; 32:721-8. [PMID: 26797500 PMCID: PMC4853443 DOI: 10.1007/s10554-016-0840-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/10/2016] [Indexed: 01/21/2023]
Abstract
Right ventricular outflow tract (RVOT) septal pacing is commonly performed under the standard fluoroscopic positions during procedure. The aim of the prospective, randomized study was to evaluate the accuracy of the combination of standard fluoroscopic and left lateral (LL) fluoroscopic views for determination of RVOT septal position compared with standard fluoroscopic views alone. We prospectively enrolled patients who had indications for implantation of a permanent pacemaker. Patients were randomly assigned into two groups based on intraoperative fluoroscopic views as follows: LL group (three standard fluoroscopic views + LL fluoroscopic view) or standard group (three standard fluoroscopic views). Transthoracic echocardiography (TTE) determination of pacing sites was applied in all patients 3 days after pacemaker implantation. The implantation success rate of RVOT septal pacing was compared between groups. A total of 143 patients (59 males, mean age 57.6 ± 16.3 years) with symptomatic bradyarrhythmia were studied, of whom, 72 patients were randomized to LL group and 71 to standard group. TTE determination of pacing sites was compared with two groups. In the LL group, 60 patients (83 %) were achieved in RVOT septal position. In the standard group, however, the position of RVOT septum was only observed in 48 patients (68 %). The success rate of RVOT septal position in LL group was significantly higher than standard group (p = 0.029). Comparing to traditional views, combining LL view in the procedure will approve the accuracy of RVOT septal pacing site.
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Affiliation(s)
- Dongli Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Jiaojiao Tang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Lie Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Chunying Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Qianhuan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Yuanhong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Silin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
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ASBACH STEFAN, LENNERZ CARSTEN, SEMMLER VERENA, GREBMER CHRISTIAN, SOLZBACH ULRICH, KLOPPE AXEL, KLEIN NORBERT, SZENDEY ISTVAN, ANDRIKOPOULOS GEORGE, TZEIS STYLIANOS, BODE CHRISTOPH, KOLB CHRISTOF. Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients-A Subanalysis of the Multicenter Randomized SPICE Trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:261-7. [DOI: 10.1111/pace.12793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/30/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- STEFAN ASBACH
- Cardiology and Angiology I; University Heart Center; Freiburg Germany
| | - CARSTEN LENNERZ
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - VERENA SEMMLER
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - CHRISTIAN GREBMER
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - ULRICH SOLZBACH
- Ostalbklinikum; Abteilung für Innere Medizin II; Aalen Germany
| | - AXEL KLOPPE
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II; Ruhr Universität Bochum; Bochum Germany
| | - NORBERT KLEIN
- Abteilung für Kardiologie und Angiologie; Universitaetsklinikum Leipzig; Leipzig Germany
| | - ISTVAN SZENDEY
- Kliniken Maria Hilf; Klinik für Kardiologie; Mönchengladbach Germany
| | | | - STYLIANOS TZEIS
- Department of Cardiology; Henry Dunant Hospital; Athens Greece
| | - CHRISTOPH BODE
- Cardiology and Angiology I; University Heart Center; Freiburg Germany
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45
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Inadequacy of fluoroscopy and electrocardiogram in predicting septal position in RVOT pacing - Validation with cardiac computed tomography. Indian Heart J 2015; 68:174-80. [PMID: 27133327 DOI: 10.1016/j.ihj.2015.10.382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Electrocardiographic (ECG) and fluoroscopic criteria, which are the only available guides to achieve a true septal position during right ventricular outflow tract (RVOT) pacing, have been infrequently validated. We sought to validate these using cardiac computed tomographic angiography (CTA) to confirm lead position within the RVOT septum. METHODS Forty-four patients with permanent pacemaker leads in the RVOT position underwent CTA. Lead positions in RVOT were classified as anterior, free wall, or septal location. Fluoroscopic images were obtained in 4 standard views. RESULTS Only 19 (43%) patients had lead in true septal position within the RVOT in CTA while 25 patients (57%) were found to have an anterior lead location. Mean QRS axis, QRS duration, negative QRS in lead I, and notching in inferior leads were not significantly different between the two groups. The standard fluoroscopic LAO view showed a rightward-directed lead not only in all 19 patients with septal location, but also in 14/25 patients in the anterior location (p=0.22), and thus had a sensitivity of 100% but specificity of only 16% in predicting true septal position. The posteriorly directed lead in left lateral view was more accurate in predicting true septal position with good sensitivity (73.7%) and excellent specificity (80%). CONCLUSIONS This study, using validation with CTA, showed that conventional ECG criteria and fluoroscopy are inaccurate in differentiating septal from anterior RVOT pacing. The fluoroscopic lateral view, as corroborated by CTA, is more reliable than the LAO view in predicting septal lead placement.
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46
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Kaye G. Pacing site in pacemaker dependency: is right ventricular septal lead position the answer? Expert Rev Cardiovasc Ther 2015; 12:1407-17. [PMID: 25418757 DOI: 10.1586/14779072.2014.979791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The right ventricular apex has been the traditional site for lead placement in patients with atrioventricular block. Pacing at the right ventricular apex may have long-term deleterious effects on left ventricular (LV) function, promoting heart failure and increasing mortality. Pacing at the right ventricular septum has been proposed to minimize deterioration in LV function. Although experimental data suggest that septal pacing protects LV function, clinical studies have provided conflicting results. A recent large study in patients with heart block did not show a protective effect with septal pacing. Other pacing approaches are becoming increasingly relevant; however, prediction of what method should be employed in which patient is not currently possible. Other factors such as baseline LV function and associated co-morbidities impact LV function, irrespective of pacing site. Continued monitoring of cardiac function post-implant is therefore critical to ongoing care. An algorithm for managing patients with atrioventricular block is proposed.
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Affiliation(s)
- Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba and University of Queensland, Brisbane 4102, Australia
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47
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HUSSAIN MOHAMMADAKHTAR, FURUYA-KANAMORI LUIS, KAYE GERALD, CLARK JUSTIN, DOI SUHAILA. The Effect of Right Ventricular Apical and Nonapical Pacing on the Short- and Long-Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1121-36. [DOI: 10.1111/pace.12681] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 01/26/2023]
Affiliation(s)
- MOHAMMAD AKHTAR HUSSAIN
- From the Division of Epidemiology and Biostatistics; School of Public Health, The University of Queensland; Brisbane Australia
| | - LUIS FURUYA-KANAMORI
- Research School of Population Health; The Australian National University; Canberra Australia
| | - GERALD KAYE
- Department of Cardiology; Princess Alexandra Hospital; Brisbane Australia
- University of Queensland Medical School; Brisbane Australia
| | - JUSTIN CLARK
- Cochrane Acute Respiratory Infections Group, Faculty of Health Sciences and Medicine, Bond University; Gold Coast Australia
| | - SUHAIL A.R. DOI
- Research School of Population Health; The Australian National University; Canberra Australia
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48
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Pang BJ, Barold SS, Mond HG. Injury to the coronary arteries and related structures by implantation of cardiac implantable electronic devices. Europace 2015; 17:524-9. [DOI: 10.1093/europace/euu345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/06/2014] [Indexed: 01/19/2023] Open
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49
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Migliore F, Zorzi A, Bertaglia E, Leoni L, Siciliano M, De Lazzari M, Ignatiuk B, Veronese M, Verlato R, Tarantini G, Iliceto S, Corrado D. Incidence, management, and prevention of right ventricular perforation by pacemaker and implantable cardioverter defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1602-9. [PMID: 25131984 DOI: 10.1111/pace.12472] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/16/2014] [Accepted: 06/09/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cardiac perforation of the right ventricle (RV) is a rare but potentially life-threatening complication of both pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant. Appropriate management is still uncertain. We assessed the incidence of subacute (24 hours-1 month) or delayed (>1 month) cardiac perforation by RV lead and the results of percutaneous lead extraction. METHOD The study population included all patients diagnosed with subacute or delayed RV-lead perforation during the period 2007-2013. The incidence of perforation according to device type and fixation mechanism was calculated. The outcome of the percutaneous approach, consisting of lead extraction by simple traction, was assessed. RESULTS Cardiac perforation was diagnosed in 14 (eight females, mean age 71 [range 47-83] years) patients out of 3,815 who received an RV-lead implant (0.4%). The overall incidence of RV-lead perforation was similar between ICD (0.3%) and PM (0.4%) implants (P = 1.0) and between active (0.5%) and passive (0.3%) fixation leads (P = 0.3). All perforating leads were originally placed at the RV apex. Five patients were asymptomatic, but all presented altered lead electrical parameters. Surgical removal of the lead was performed in one patient while in the remaining the leads were successfully extracted by direct manual traction in the absence of any complications. In all patients, new active fixation leads were positioned in the RV septum and the follow-up (42 ± 27 months) was uneventful. CONCLUSIONS RV perforation is a rare complication of both PM and ICD implants, regardless of the lead fixation mechanism. In most patients, percutaneous lead extraction is a safe and effective management approach.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
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50
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PANG BENJAMINJ, JOSHI SUBODHB, LUI ELAINEH, TACEY MARKA, ALISON JEFF, SENEVIRATNE SUJITHK, CAMERON JAMESD, MOND HARRYG. Proximity of Pacemaker and Implantable Cardioverter-Defibrillator Leads to Coronary Arteries as Assessed by Cardiac Computed Tomography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:717-23. [DOI: 10.1111/pace.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 01/16/2023]
Affiliation(s)
- BENJAMIN J. PANG
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
- Department of Medicine; University of Melbourne; Victoria Australia
| | - SUBODH B. JOSHI
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
| | - ELAINE H. LUI
- Department of Radiology; Royal Melbourne Hospital & University of Melbourne; Victoria Australia
| | - MARK A. TACEY
- Melbourne EpiCentre; University of Melbourne; Victoria Australia
| | - JEFF ALISON
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - SUJITH K. SENEVIRATNE
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - JAMES D. CAMERON
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - HARRY G. MOND
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
- Department of Medicine; University of Melbourne; Victoria Australia
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