Open Access

The usefulness of right ventriculography to aid anchoring a pacing lead to the right ventricular septum

logo

Date: 30 June 2017
Journal: EP Europace Journal , Volume 20 , Issue 7 , Pages 1154 - 1160
Authors: K. Shimeno , T. Yoshiyama , Y. Abe , K. Akamatsu , S. Kagawa , T. Matsushita , M. Matsuo , Y. Matsumura , R. Matsumoto , K. Kamimori , T. Naruko , A. Doi , M. Takagi , M. Yoshiyama

ESC Journals

AbstractAims

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.

About the contributors

Kenji Shimeno

Osaka (Osaka City General Hospital)

Role: Author

Tomotaka Yoshiyama

Role: Author

Yukio Abe

Role: Author