Angiography‐guided mid/high septal implantation of ventricular leads in patients with congenital heart disease

Figures

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  CHART 1. Pie diagram showing lead tip position. The chart shows the final lead tip position in 22 of the 27 patients who underwent computed tomography. The majority (91%) of the leads were placed in the mid/high septum. The lead tip was positioned in the apical septum in 9% for anatomical reasons.

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  FIGURE 1. Angiogram of dual‐chamber pacemaker situs inversus, d‐transposition of great arteries, double‐outlet right ventricle, and cardiac total anomalous pulmonary venous connection. 13‐year‐old female patient post arterial switch, atrial septectomy, Senning procedure with ventricular septal defect closure and malfunctioning epicardial VVI pacemaker. (A) shows the angiogram's AP view depicting the MRA, systemic venous baffle to the MLA. (B) illustrates the angiogram in RAO 30° the morphologic left atrium, morphologic right ventricle right pulmonary arteries. (C, D) Fluoroscopy in the LAO and RAO views, showing the final ventricular lead tip position in the mid‐septal area of the morphologic right ventricle. The yellow arrow (Epi) shows the position of the epicardial lead. AP, anteroposterior; AV, atrioventricular; Epi, epicardial pacing lead; IVC, inferior vena cava; LAO, left anterior oblique; LPA, left pulmonary artery; LSVC, left superior vena cava; MLA, morphologic left atrium; MPA, main pulmonary artery; MRA, morphologic right atrium; MRV, morphologic right ventricle; RAO, right anterior oblique; RPA, right pulmonary artery; SV, systemic venous

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  FIGURE 2. Computed tomographic reconstruction and angiogram of the dual‐chamber pacing system in a patient with situs inversus, dextrocardia, and corrected transposition of the great arteries. The left panels show computed tomographic three‐dimensional reconstructions of the heart. (A) Left anterior oblique, (C) Right anterior oblique, and (E) Anteroposterior views with the pacing lead tip position. Right panels (B), (D), and (F) show procedural angiographic images in the same views as (A), (C), and (E), showing ventricular lead position in the mid‐septal area in the morphological left ventricle, as confirmed by cardiac computed tomography. AP, anteroposterior; LAO, left anterior oblique; LV, left ventricle; RA, right atrium; RV, right ventricle; RAA, right atrial appendage; RAO, right anterior oblique; PA, pulmonary artery

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  FIGURE 3. Angiogram of the dual‐chamber pacing system in a patient with Ebstein's anomaly. (A) LAO and (C) RAO view angiograms during ventricular lead placement. (E) The final lead position in the right anterior oblique view. (B), (D), and (F) Angiograms with outlines of the chambers illustrated. The ventricular lead is beyond the displaced tricuspid valve in the high septal position. ARV, atrialized right ventricle; FRV, functional right ventricle; LAO, left anterior oblique; PA, pulmonary artery; RA, right atrium; RAA, right atrial appendage; RAO, right anterior oblique; RV, right ventricle

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  FIGURE 4. Three‐dimensional reconstruction of computed tomography and angiogram of the dual‐chamber pacing system in a patient with congenitally corrected transposition of the great arteries with persistent left superior vena cava. Computed tomographic three‐dimensional reconstructions of the heart in (A) AP, (C) RAO, and (E) LAO views showing pacing lead tip position. (B), (D), and (F) show procedural angiograms in equivalent views as the top panel. The ventricular lead is in the high‐septal location in the morphological left ventricle, and the atrial lead is in the right atrial appendage. AP, anteroposterior; LAO, left anterior oblique; LV, left ventricle; LVOT, left ventricular outflow tract; LSVC, left superior vena cava; RAA, right atrial appendage; RAO, right anterior oblique; RV, right ventricle

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  FIGURE 5. Three‐dimensional reconstruction of computed tomography and angiogram of the dual‐chamber pacemaker in a patient with congenitally corrected transposition of the great arteries, inlet ventricular septal defect, and Eisenmenger syndrome. Computed tomographic three‐dimensional reconstructions of the heart in (A) AP, (C) RAO, and (E) LAO views with the pacing lead tip position. (B), (D), and (F) show procedural angiograms in equivalent views as the left panel, demonstrating ventricular lead position at the apical septal location in the morphological left ventricle. AP, anteroposterior; LAO, left anterior oblique; LV, left ventricle; LVOT, left ventricular outflow tract; RA, right atrium; RAO, right anterior oblique; RV, right ventricle