Surface ECG Criteria During Pacemaker Implantation are Not Predictive of Right Ventricular Septal Pacing Lead Position when Compared to Cardiac CT

2016 ◽  
Vol 25 ◽  
pp. S155-S156
Author(s):  
M. Rowe ◽  
P. Moore ◽  
J. Pratap ◽  
J. Coucher ◽  
P. Gould ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Cardiac Ct ◽  
Pacemaker Implantation ◽  
Lead Position ◽  
Surface Ecg ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Ecg Criteria

scholarly journals Usefulness of lead delivery catheter system for true right ventricular septal pacing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Miyajima ◽  
T Urushida ◽  
K Ito ◽  
F Kin ◽  
A Okazaki ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Septal Wall ◽  
Catheter Group ◽  
Catheter System ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Pacing Lead ◽  
Guiding Catheter ◽  
Delivery Catheter

Abstract Background Right ventricular (RV) septal pacing is often selected to preserve a more physiologic ventricular activation. But the pacing leads are not always located in true septal wall, rather in hinge or free wall in some cases with the conventional stylet-guided lead implantation. In recent years, new guiding catheter systems has attracted attention as a solution to that problem. Objective The aim of this study is to investigate that true ventricular sepal pacing can be achieved by use of the new guiding catheter system for pacing lead. Methods We enrolled 198 patients who underwent RV septal lead implantation and computed tomography (CT) after pacemaker implantation. 16 cases were used delivery catheter (Delivery), and 182 cases were used stylet for targeting ventricular septum (Conventional). We analyzed the lead locations with CT, and evaluated capture thresholds, R-wave amplitudes, lead impedances and 12-lead electrocardiogram findings one month after implantation. Results All cases of delivery catheter group had true septal lead positions (Delivery; 100% vs Conventional; 44%, p<0.01). Capture thresholds and lead impedances had not significant differences between between two groups (0.65±0.15V vs 0.60±0.15V, p=0.21, 570±95Ω vs 595±107Ω, p=0.39, respectively). R-wave amplitudes were significantly higher in delivery catheter group (13.0±4.8mV vs 10±4.6mV, p<0.01). Paced QRS durations were shorter in delivery catheter group (128±16ms vs 150±21ms, p<0.01). Conclusions The delivery catheter system designated for pacing lead can contribute to select the true ventricular septal sites and to attain the more physiologic ventricular activation. Funding Acknowledgement Type of funding source: None

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

2017 ◽  
Vol 40 (5) ◽  
pp. 537-544 ◽  
Author(s):  
MATTHEW K. ROWE ◽  
PETER MOORE ◽  
JIT PRATAP ◽  
JOHN COUCHER ◽  
PAUL A. GOULD ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Cardiac Ct ◽  
Lead Position ◽  
Surface Ecg

scholarly journals 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 ◽  
Vol 11 (5) ◽  
pp. e046782
Author(s):  
Yoshihisa Naruse ◽  
Keisuke Miyajima ◽  
Ryo Sugiura ◽  
Masahiro Muto ◽  
Michio Ogano ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Right Ventricular ◽  
Success Rate ◽  
Cardiac Ct ◽  
Controlled Trial ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Lead Placement ◽  
Randomised Controlled ◽  
Delivery Catheter

IntroductionPacing-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 analysisIn 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 disseminationThis 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 numberjRCTs042200014; Pre-results.

Late unexpected complete fracture of a right ventricular lead still capturing the myocardium

2021 ◽  
Vol 14 (8) ◽  
pp. e244087
Author(s):  
Teona Serafimova ◽  
Georgia May Connolly ◽  
Eva Sammut ◽  
Ihab Diab
Keyword(s):  
Right Ventricular ◽  
Late Complication ◽  
Pacemaker Implantation ◽  
Complete Separation ◽  
Lead Fracture ◽  
Ventricular Lead ◽  
Pacing Lead ◽  
Chest X Ray ◽  
Rv Pacing ◽  
The Right

A 72-year-old man presented for routine dual chamber pacemaker interrogation 13 years following insertion for sick sinus syndrome. Increased noise, impedance and threshold of the right ventricular (RV) lead were identified. RV capture was maintained with an overall RV pacing burden of 47%. A routine generator replacement was scheduled alongside RV lead replacement. Fluoroscopy at the start of the procedure revealed an unexpected striking fracture of the RV pacing lead with complete separation of the proximal and distal portions within the RV. The patient was asymptomatic and described no predisposing factors. He underwent implantation of a new ventricular lead and generator and has remained well. This case demonstrates clear RV lead fracture as a late complication of pacemaker implantation despite maintained capture. This emphasises the need for a chest X-ray when a change in device parameters is noted at device interrogation even in the absence of symptoms.

scholarly journals Programmed deep septal pacing for the diagnosis of left bundle branch capture

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Aleksander Kusiak ◽  
Agnieszka Bednarek ◽  
Tomasz Sondej ◽  
...  
Keyword(s):  
Refractory Period ◽  
Pacemaker Implantation ◽  
Drive Train ◽  
Effective Refractory Period ◽  
Qrs Complex ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Qrs Morphology ◽  
Premature Beats ◽  
Septal Myocardium

AbstractBackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB) capture.ObjectiveThe effective refractory period (ERP) of the working myocardium is different than the ERP of the LBB; we hypothesized that it should be possible to differentiate LBB capture from septal myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients undergoing pacemaker implantation who received pacing lead in a deep septal position programmed pacing was delivered from this lead. Responses to programmed pacing were categorized on the basis of QRS morphology of the extrastimuli as: myocardial (broader QRS, often slurred), selective (narrower QRS, preceded by an isoelectric interval) or non-diagnostic (unequivocal change).ResultsProgrammed deep septal pacing was performed 269 times in 143 patients; in every patient with the use of an 8-beat basic drive train of 600 ms and when possible also during supraventricular rhythm. Responses diagnostic for LBB capture were observed in 114 (79.7%) of patients. Selective LBB paced QRS was more often seen when premature beats were introduced during the intrinsic rhythm rather than after the basic drive train. The average septal-myocardial refractory period was significantly shorter than the LBB refractory period: 263.0±34.4 ms vs. 318.0±37.4 ms.ConclusionsA novel maneuver for the diagnosis of LBB capture during deep septal pacing, was formulated, assessed and found as diagnostically valuable. This method, based on the differences in refractoriness between LBB and the septal myocardium is unique in enabling the visualization of components of the usually fused, non-selective LBB paced QRS complex.Graphical abstract

Surface ECG criteria can discriminate post-septal pacing cardiac memory from ischemic T wave inversions

2020 ◽  
Vol 58 ◽  
pp. 10-17
Author(s):  
Maria-Claudia-Berenice Suran ◽  
Andrei-Dumitru Margulescu ◽  
Ramona Bruja ◽  
Calin Siliste ◽  
Dragos Vinereanu
Keyword(s):  
Cardiac Memory ◽  
T Wave ◽  
Surface Ecg ◽  
Septal Pacing ◽  
Ecg Criteria

Validation of Conventional Fluoroscopic and ECG Criteria for Right Ventricular Pacemaker Lead Position Using Cardiac Computed Tomography

2013 ◽  
Vol 37 (4) ◽  
pp. 495-504 ◽  
Author(s):  
BENJAMIN J. PANG ◽  
SUBODH B. JOSHI ◽  
ELAINE H. LUI ◽  
MARK A. TACEY ◽  
LIANG-HAN LING ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Right Ventricular ◽  
Cardiac Computed Tomography ◽  
Pacemaker Lead ◽  
Lead Position ◽  
Ecg Criteria
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