Right Ventricular Pacing and Sensing Function in High Posterior Septal and Apical Lead Placement in Cardiac Resynchronization Therapy

Abstract

BackgroundThe conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.MethodsTwo hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5ms and 2.5V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24 months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation.ResultsRV pacing leads were implanted in RV-A (n=79) and RV-HS (n=156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5ms were 0.77±0.69V in RV-A and 0.71±0.35V in RV-HS (P=0.31), and at 2.5V were 0.06±0.08ms in RV-A and 0.07±0.05ms in RV-HS (P=0.12). Average RV electrogram amplitudes from baseline to 24 months after CRT were 15.3±6.9mV in RV-A and 12.1±6.0mV in RV-HS (P=0.55). Average RV impedances during follow-up were 850±286Ω in RV-A and 618±147Ω in RV-HS (P=0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P=0.55).ConclusionThe RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P.

Trends in implantable cardioverter defibrillator and cardiac resynchronisation therapy lead parameters for patients with arrhythmogenic and dilated cardiomyopathies

“…compared septal and apical lead placement, and found that position in itself does not affect R wave amplitude or threshold significantly in patients with pacemakers [6], findings supported by Kristiansen et al. in the setting of CRT [5]. Thus, it seems the RV lead threshold changes observed in the DCM group in our study are likely disease, rather than lead–related.…”

A long-term, prospective, cohort study on the performance of right ventricular pacing leads: comparison of active-fixation with passive-fixation leads

“…The right ventricular apex is by far the most common pacing site, but active fixation steroid-eluting leads with a stable performance, low rate of dislodgement, and screwable design have made selecting pacing sites other than the right ventricular apex possible. Active fixation leads also provide the added convenience of possible lead extraction 9 10 . With an increasing number of pacemaker implantations and senior populations 11 , active-fixation pacing leads, have played a dominant role in Europe and the U.S.…”

The effect of right ventricular pacemaker lead position on functional status in patients with preserved left ventricular ejection fraction

“…The authors have concluded on the basis of the literature data published so far that the QRS duration in RVOT stimulation is shorter than in RVA stimulation [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Other authors also showed that QRS duration in the patients from the RVOT group was statistically significantly shorter than in the patients from the RVA group, but it had no protective effect on the left ventricular systolic function.…”