Key result
Right ventricular high posterior septal lead placement demonstrated similar average pacing thresholds at 0.5ms compared to apical placement (0.71V vs 0.77V, P=0.31) over 24 months.
Why the study?
Does right ventricular high posterior septal lead placement provide comparable electrophysiological stability and complication rates to apical placement in patients receiving CRT-P?
Observational (n=235)
Does right ventricular high posterior septal lead placement provide comparable electrophysiological stability and complication rates to apical placement in patients receiving CRT-P?
Absolute Event Rate: 0.71% vs 0.77%
p-value: p=0.31
Right ventricular high posterior septal lead placement in CRT-P is feasible and demonstrates comparable long-term electrophysiological stability and complication rates to conventional apical placement.
Supports septal RV lead placement as alternative in CRT-P; leaves open confirmation of equivalence in randomized trials.
BACKGROUND: The 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. METHODS: Two 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. RESULTS: RV 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). CONCLUSION: The 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.
No takes yet. Share an insight, caveat, or question.
Kristiansen et al. (2012) conducted an observational in Cardiac resynchronization therapy (n=235). Right ventricular high posterior septal (RV-HS) lead position vs. Right ventricular apex (RV-A) lead position was evaluated on Average RV pacing thresholds at 0.5ms (p=0.31). Right ventricular high posterior septal lead placement demonstrated similar average pacing thresholds at 0.5ms compared to apical placement (0.71V vs 0.77V, P=0.31) over 24 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: