Key result
Right ventricular angiography-guided pacemaker implantation achieved a higher rate of CT-validated mid-septal lead positioning compared to conventional fluoroscopy (88.5% vs 40.7%, P=0.0003).
Why the study?
Fluoroscopic and electrocardiogram criteria are unreliable for predicting the RV mid-septal lead position, prompting an investigation into using RV angiography to define the optimal site.
Does right ventricular angiography-guided implantation improve the accuracy of right ventricular mid-septal lead positioning compared to conventional fluoroscopy in patients undergoing pacemaker implantation?
RCT (n=53)
randomized
Does right ventricular angiography-guided implantation improve the accuracy of right ventricular mid-septal lead positioning compared to conventional fluoroscopy in patients undergoing pacemaker implantation?
Absolute Event Rate: 88.5% vs 40.7%
p-value: p=0.0003
Angiography-guided RV mid-septal pacing may refine lead placement; leaves open whether it improves outcomes versus fluoroscopy in larger trials.
Background Right ventricular (RV) mid‐septal pacing has been proposed as an alternative to RV apical pacing. Fluoroscopic and electrocardiogram criteria are unreliable for predicting the RV mid‐septal lead position. This study aimed to define the optimal RV mid‐septal pacing site using RV angiography. Methods We randomized patients undergoing pacemaker implantation (PPM) to the RV angiography‐guided group (Group A) or conventional fluoroscopy‐guided group (Group F). In Group A, we performed an angiogram in right anterior oblique (RAO 30°), left anterior oblique (LAO 40°), and left lateral (LL) views. We made a 5‐segment grid in RAO 30° and LL views and a 3‐segment grid in LAO 40° on the angiographic silhouette to define the lead position. Computed tomography (CT) was used to validate the lead tip position in both groups. Results We enrolled 53 patients (Group A: 26, Group F: 27) with a mean age of 55.9 ± 12.2 years. CT images validated the lead position in the mid‐septum (Group A, 23 [88.5%]; Group F, 11 [40.7%], P = .0003) and anteroseptal (Group A, 3 [11.5%]; Group F, 5 [18.5%], P = .24). In Group F, the lead was in the anterior wall in 9 patients (33.3%) and the right ventricular outflow tract in 2 (7.4%) patients and none in these two positions in Group A. The lead tip in segment one on the angiographic 5‐segment grid in RAO 30° and LL views indicated a mid‐septal lead position on CT. Conclusions RV angiography is safe and may be used to confirm the mid‐septal lead position during PPM.
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Shenthar et al. (2021) conducted an RCT in Pacemaker implantation (n=53). Right ventricular angiography-guided implantation vs. Conventional fluoroscopy-guided implantation was evaluated on CT-validated lead position in the mid-septum (p=0.0003). Right ventricular angiography-guided pacemaker implantation achieved a higher rate of CT-validated mid-septal lead positioning compared to conventional fluoroscopy (88.5% vs 40.7%, P=0.0003).
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