Key result
Introducing more lead into the right ventricular chamber altered the angle of lead attachment by a mean of 14.6°, but the template score remained within the same zone in 87% of patients.
Why the study?
Does the introduction of a lead loop alter the template score for evaluating alternate right ventricular pacing sites in patients undergoing RV pacing?
Observational (n=23)
Does the introduction of a lead loop alter the template score for evaluating alternate right ventricular pacing sites in patients undergoing RV pacing?
The angle of RV pacing lead attachment changes with the introduction of more lead, but the template score remains largely consistent, suggesting its potential utility for evaluating alternate RV pacing sites.
Template scores appear robust to lead loop variations in RV pacing; leaves open prospective validation before clinical use.
BACKGROUND: Prolonged right ventricular (RV) apical pacing produces dysynchronous ventricular contraction, which may result in left ventricular (LV) dysfunction, whereas septal pacing sites might reflect a more synchronous LV activation. This study examined a method of evaluating alternate RV pacing sites using a template scoring system based on measuring the angle of lead attachment in the 40° left anterior oblique (LAO) fluoroscopic view and its effect on altering the loop of lead in the RV. METHODS: Twenty-three consecutive patients for RV pacing were enrolled. Conventional active fixation leads were positioned in either the RV outflow tract (RVOT) or mid RV using a stylet designed for septal placement (Model 4140, St. Jude Medical, St. Paul, MN, USA). Using LAO cine fluoroscopy, a generous loop of lead was inserted into the RV chamber and the change in angle of attachment determined. RESULTS: Successful positioning of pacing leads at the RVOT septum (18 patients) and mid-RV septum (five patients) was achieved. With introduction of more lead into the RV chamber, the angle of attachment in the LAO projection altered over a range of 6°-32° for all patients with a mean of 14.6 ± 6.6°. In 87% of patients, the range was predominantly within the same template score with only minor overlap into another zone. CONCLUSIONS: This study shows that the angle of lead attachment in the RV is altered by introducing more lead, but in most cases, the template score remains the same. Further studies are required to determine the accuracy and efficacy of the templates.
No takes yet. Share an insight, caveat, or question.
Mond et al. (2011) conducted an observational in Patients requiring right ventricular pacing (n=23). Introduction of a generous loop of lead into the right ventricular chamber was evaluated on Change in angle of lead attachment in the 40° left anterior oblique fluoroscopic view. Introducing more lead into the right ventricular chamber altered the angle of lead attachment by a mean of 14.6°, but the template score remained within the same zone in 87% of patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: