A Prospective Randomized Trial of Defibrillation Thresholds from the Right Ventricular Outflow Tract and the Right Ventricular Apex

Crossley, George H.; Boyce, Ker; Roelke, Marc; Evans, Joseph J.; Dalal, Yousuf; Syed, Zeeshan; Vicari, Ralph

doi:10.1111/j.1540-8159.2008.02198.x

Cited by 28 publications

(24 citation statements)

References 7 publications

(15 reference statements)

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“…Our results are similar to previous studies [11][12][13][14]. Giudici et al (14) described their experience with a smaller cohort of 112 patients with RVNA defibrillator lead with an average follow up of 22.5 months [14].…”

Section: Discussionsupporting

confidence: 93%

“…Over time many patients with ICDs may require pacing due to a combination of disease progression, the effect of adjunctive drug therapy and the development of sinus and atrioventricular node disease. Previous studies have demonstrated that ICD leads placed in the RVNA have similar defibrillation thresholds [11][12][13] and long-term stability and performance as leads placed in the RV apex [13,14].…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

A Comparison of Right Ventricular Non-apical Defibrillator Lead Position with Traditional Right Ventricular Apical Position: A Single Centre Experience

Kaye

Eng

Hunt

et al. 2015

Heart, Lung and Circulation

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 98%

A Comparison of Right Ventricular Non-apical Defibrillator Lead Position with Traditional Right Ventricular Apical Position: A Single Centre Experience

Kaye

Eng

Hunt

et al. 2015

Heart, Lung and Circulation

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“…Concerning defibrillation catheters, given their greater rigidity, it was supposed that the risk of perforation would be less elevated if infundibular septal pacing was conducted without affecting the pacing and defibrillation thresholds, as already discussed [28,[48][49][50]. The only randomized study designed to evaluate the feasibility and performance of RV mid-septal versus apical implantable defibrillator lead placement was recently published by Mabo et al [50].…”

Section: Septal Pacing and Defibrillation Leadsmentioning

confidence: 99%

Focus on right ventricular outflow tract septal pacing

Costa

Laurent

Romeyer‐Bouchard

et al. 2013

Archives of Cardiovascular Diseases

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Experimental and clinical studies have shown that right ventricular apical pacing may result in long-term deleterious effects on account of its negative impact on left ventricular remodeling through desynchronization. This risk appears more pronounced in patients with even moderate left ventricular dysfunction and generally occurs after at least 1 year of pacing. As right ventricular apical pacing may be associated with the development of organic mitral insufficiency, other sites that allow for more physiological stimulation, such as right ventricular outflow tract septal pacing, have been developed, with good feasibility and reproducibility. However, the prospective randomized studies and meta-analyses to date have only demonstrated a modest effect on ejection fraction in the medium term, without any significant effect on quality of life and morbimortality. However, the absence of a favorable effect for right ventricular outflow tract septal pacing compared with right ventricular apical pacing in terms of clinical manifestations and patient prognosis appears to be more associated with the designs of these studies, which were not homogeneous with regard to methodology used, judgment criteria, follow-up and, especially, statistical power. Two randomized prospective multicentre studies are currently ongoing in order to evaluate the favorable effect of infundibular septal pacing, when considering the indirect negative effects of right ventricular apical pacing as reported in the literature.

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“…[25][26][27] Furthermore, the place of MES was most commonly found in the septal locations, a site not commonly used in CRT-D. Septal placement of the implantable cardioverter defibrillator lead has good evidence for safety. 24 In our series, there were no implantable cardioverter defibrillator lead dislodgments, and the defibrillator test was successfully performed.In pacemakers, septal pacing has shown benefits over apical pacing in terms of LV function and synchrony. 19,20 Long-term apical pacing has been associated with interventricular dyssynchrony and HF.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Maximal Electric Separation–Guided Placement of Right Ventricular Lead Improves Responders in Cardiac Resynchronization Defibrillator Therapy

Miranda

Nault

Johri

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Cardiac resynchronization therapy is widely used for the treatment of heart failure. Recent data suggest that electric separation during left ventricular pacing varies within the right ventricle (RV). We hypothesized that placement of the RV lead guided by maximal electric separation (MES) would improve response to cardiac resynchronization therapy compared with standard apical placement. Methods and Results-A single-blind, randomized controlled trial was conducted. Patients eligible for cardiac resynchronization therapy-D were enrolled. Left ventricular lead placement was performed at the coronary sinus branch. The RV outflow tract, septum, and apex were mapped during left ventricular pacing and MES recorded. Patients were randomized to receive either apical placement or RV lead placement at the site mapping MES. Left ventricular ejection fraction, 6-minute walk distance, and New York Heart Association functional class were recorded at baseline and 3 months by blinded observers. Response was defined as at least one of the following: 5% absolute increase in ejection fraction, 50 m increase in 6-minute walk distance, or an increase by >1 functional class. Primary end point was improvement in ejection fraction at 3 months. Fifty patients were randomized (25 MES-guided and 25 apical). Baseline characteristics were similar in the 2 groups. Electric separation was lower in the apex (143±23 versus 168±25 ms in MES group; P=0.01). MES was most commonly septal and rarely apical (4/50 patients). Responders in the MES-guided versus apical group are as follows: Echo 21 versus 13 patients (P=0.032), 6-minute walk distance 19 versus 12 patients (P=0.079), and functional class 22 versus 15 patients (P=0.051). No dislodgment or reposition for suboptimal defibrillation tests was reported. Conclusions-MES-guided PatientsConsecutive patients with conventional indications for CRT were recruited. The indication for CRT was standard according to current clinical guidelines: symptomatic HF despite optimal medical therapy, LV ejection fraction (EF) <35%, sinus rhythm, and QRS ≥120 ms with left bundle branch block morphology. Exclusion criteria were preexisting devices attending for upgrades, atrial arrhythmia, or inability to place the LV lead ( Figure 1). CRT devices were implanted as previously described. 23 Briefly, a 6947 dual-coil, high-voltage lead (Medtronic Inc, Minneapolis, MN) was placed at the RV apex to provide back-up pacing in the event of inadvertent atrioventricular block during CS lead placement. The LV lead was sited in the posterolateral branch (first option), lateral branch (second option), or middle cardiac vein (third option) of the CS. After satisfactory positioning of the LV lead, a deflectable catheter (Polaris, Boston Scientific, Natick, MA) was used to map the RV from RV outflow tract (RVOT) to apex, with care to avoid the anterior free wall. After completion of the protocol, this catheter was removed and replaced with a 5076 or 4076 active fixation pacing lead (Medtronic Inc, Minneapolis, MN) pl...

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A Prospective Randomized Trial of Defibrillation Thresholds from the Right Ventricular Outflow Tract and the Right Ventricular Apex

Abstract: DFTs in leads placed in the RVOT and RVA are comparable. RVOT ICD lead placement is safe and exhibits similar lead stability, threshold, and impedance measurements as the traditional RVA location.

Cited by 28 publications

References 7 publications

A Comparison of Right Ventricular Non-apical Defibrillator Lead Position with Traditional Right Ventricular Apical Position: A Single Centre Experience

A Comparison of Right Ventricular Non-apical Defibrillator Lead Position with Traditional Right Ventricular Apical Position: A Single Centre Experience

Focus on right ventricular outflow tract septal pacing

Maximal Electric Separation–Guided Placement of Right Ventricular Lead Improves Responders in Cardiac Resynchronization Defibrillator Therapy

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