Key result
Placement of right ventricular active-fixation leads on the septum avoids potential coronary artery compromise, whereas anterior wall positioning is in close proximity to the LAD.
Why the study?
Does right ventricular septal pacing lead placement avoid danger to the coronary arteries compared to anterior wall placement in patients with RV active-fixation leads?
Case Report (n=3)
Does right ventricular septal pacing lead placement avoid danger to the coronary arteries compared to anterior wall placement in patients with RV active-fixation leads?
Placement of right ventricular active-fixation leads on the septum or free wall, rather than the anterior wall, avoids potential compromise of the left anterior descending coronary artery.
Anterior RV lead placement may risk LAD compromise; leaves open whether septal positioning reduces events in larger cohorts.
BACKGROUND: Pacing from right ventricular (RV) septal sites has been suggested as an alternative to RV apical pacing in an attempt to avoid long-term adverse consequences on left ventricular function. Concern has been raised as to the relationship of the left anterior descending coronary artery (LAD) to pacing leads in these positions. METHODS AND RESULTS: We retrospectively analyzed three cases in which patients with RV active-fixation leads in situ also had coronary angiography. Multiple fluoroscopic views were used to determine the relationship of the lead tip at various pacing sites to the coronary arteries. A lead placed on the anterior wall was in close proximity to the LAD, whereas septal and free wall positioning was not. CONCLUSION: Placement of RV active-fixation leads on the septum avoids potential coronary artery compromise.
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Teh et al. (2009) conducted a case report in Patients with right ventricular active-fixation leads (n=3). Right ventricular active-fixation leads on the septum vs. Anterior wall positioning was evaluated on Relationship of the lead tip at various pacing sites to the coronary arteries. Placement of right ventricular active-fixation leads on the septum avoids potential coronary artery compromise, whereas anterior wall positioning is in close proximity to the LAD.
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