Imaging and Right Ventricular Pacing Lead Position: A Comparison of CT, MRI, and Echocardiography

Moore, Peter; Coucher, John; Ngai, Stanley; Stanton, Tony; Wahi, S.; Gould, Paul A.; Booth, Cameron; Pratap, Jit; Kaye, G.

doi:10.1111/pace.12817

Cited by 24 publications

(35 citation statements)

References 32 publications

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“…Therefore, these pacing sites are accurately positioned in the RV. Moreover, we confirmed the position of the lead implanted in the RVMS using postprocedural CT. CT evaluation is reported to be more accurate than echocardiography for determining the position of the RV lead . Thus, we used CT after the PPM implantation and chose the patients whose RV leads were placed in the RVMS.…”

Section: Discussionmentioning

confidence: 99%

Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing

Matsuo

Shimeno

Yoshiyama

et al. 2019

Cardiovasc electrophysiol

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Introduction The electrocardiograms (ECG) criteria to anchor the lead to the right ventricular septum have not been established. This study aimed to identify ECG criteria of pacing at the right ventricular mid septum (RVMS) and investigate whether the paced QRS duration (pQRSd) from the RVMS was narrow. Methods and results In 42 patients, ECG pacing at the basal anterior wall (BA), mid‐anterior wall (MA), apex (AP), and mid septum (MS) was recorded. The pacing sites were validated by using right ventriculography and computed tomography. We estimated the ECG parameters and compared them among the four pacing sites. The combination of simple four paced‐ECG parameters could reliably confirm the pacing at the RVMS. The area under the receiver‐operating characteristics curve for the number of positive findings among the following: (a) positive QRS in lead aVL, (b) QRS notching in lead I, (c) precordial leads transition at less than V5, and (d) presence of isoelectric QRS in the inferior leads was 0.95 (95% confidence interval, 0.91‐0.98) and the number of positive findings (≥3) had a sensitivity of 83.3% and a specificity of 93.7% for discriminating MS from the other sites. The pQRSd with three or more positive findings was significantly narrower than that with less than three positive findings (≥3: 137.4 ± 9.2 ms, <3: 151.8 ± 13.1 ms, P ≤ .05). Conclusion The combination of ECG parameters can help identify right ventricular mid‐septal pacing. The use of these parameters may enable the implantation of the pacing lead in the RVMS accurately and obtain a narrower QRS duration.

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Section: Discussionmentioning

confidence: 99%

Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing

Matsuo

Shimeno

Yoshiyama

et al. 2019

Cardiovasc electrophysiol

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“…Successful septal lead placement during implant with standard active fixation leads is often only around 60 to 70% . Although CT and 3D echocardiography may provide more accurate anatomic localisation, their clinical utility in ensuring the desired lead position is limited as they apply only after implantation . Even modifications in lead stylet design have not resulted in significantly improved septal lead success .…”

Section: Right Ventricular Septal Pacingmentioning

confidence: 99%

“…Although there is good theoretical evidence that pacing in the septum may provide some protection of left ventricular function, it is evident that reliable placement of a lead at the true septum is difficult. This may be one of the factors accounting for discordant clinical study outcomes . However, three meta‐analyses suggest that septal pacing is no worse than apical pacing and, in studies of longer than 12 months duration, support a positive outcome for septal pacing .…”

Section: Right Ventricular Septal Pacingmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

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Pacing is a well established therapy for bradycardia support and certain types of heart failure. Despite technological advances the optimal pacing lead position remains controversial. Right ventricular pacing, particularly apical has been the site of choice but the induction of abnormal cardiac depolarization and the recognition of an increased risk of impairment of left ventricular systolic function, heart failure and mortality has driven a desire for a true physiological pacing system. A number of different lead positions have been determined and of these His bundle pacing appears to most closely mimic normal ventricular conduction. This article reviews the background to the development of physiological pacing, evaluates historical data for right ventricular pacing and the basis for change and new lead positions.

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“…The methodology to localize lead tip on CT has previously been published . In summary, a modified ECG‐gated CT coronary angiography protocol was performed using a dual‐source 128‐slice Siemens Definition Flash CT scanner (Siemens, Erlangen, Germany).…”

Section: Ecg‐gated Multidetector Ct (Mdct)mentioning

confidence: 99%

“…However, the diluted infusion of contrast following the bolus injection provided a clear outline of the RV endocardial cavity, and allowed enhanced identification of the septum, providing better anatomical definition of the lead tip. As a result, this method was used to define final lead tip position . Movement artifact of the lead tip was minimal due to rapid image acquisition.…”

Section: Ecg‐gated Multidetector Ct (Mdct)mentioning

confidence: 99%

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

Rowe

Moore

Pratap

et al. 2017

Pacing Clinical Electrophis

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Imaging and Right Ventricular Pacing Lead Position: A Comparison of CT, MRI, and Echocardiography

Cited by 24 publications

References 32 publications

Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing

Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing

The desire for physiological pacing: Are we there yet?

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

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