Key result
CT reveals ~43% discordance in leadless pacemaker placement, with non-septal positions yielding wider paced QRS.
Why the study?
Fluoroscopic localization of leadless pacemakers is often unreliable, and the accuracy and implications of device deployment under current standards of practice remained poorly identified.
Does CT verification identify misclassification of procedure-note–reported leadless pacemaker position and is non-septal placement associated with wider paced QRS duration in patients undergoing leadless pacemaker implantation?
Observational (n=92)
Yes
Does CT verification identify misclassification of procedure-note–reported leadless pacemaker position and is non-septal placement associated with wider paced QRS duration in patients undergoing leadless pacemaker implantation?
Nearly half of leadless pacemaker implants had misclassified positions on procedure notes compared to CT, with common non-septal and free-wall placements resulting in significantly wider paced QRS durations.
Background Optimal safety and performance of leadless pacemakers (LPMs) depend on mid-to-apical septal placement, whereas non-septal positions increase risks of perforation, dyssynchrony, and pacing-induced cardiomyopathy. Fluoroscopic localization is often unreliable with spatial localization. The accuracy and implications of device deployment with the current standards of practice is still poorly identified. Objective We evaluated the accuracy of procedure-note–reported LPM location against CT-verified position and assessed the association of the CT-adjudicated positions with baseline characteristics, right ventricular (RV) measurements, and paced QRS duration. Methods We included consecutive patients who underwent LPM implantation and contrast-enhanced CT of optimal quality at three tertiary centers (2015–2024). The right ventricle was segmented into mid/high-septal, apical-septal, apical, apical free-wall, and mid/high free-wall regions. CT-verified location (two independent readers) was compared with procedure-note–reported position. Baseline characteristics, CT measurements, and paced QRS were compared between septal and non-septal locations. Results Of 540 screened LPM patients, 92 were eligible (mean age 76±9.8 years, 31% females; Table 1). Mean paced QRS duration was 174 ms (±16.9), with 72% having a QRS duration >160 ms. About 42.5% had ≥1-segment discordance between procedure note and CT location (Figure 1). Twenty-seven percent had the device implanted on the apical (17%) or mid/high (10%) free-wall (Figure 2). CT-verified non-septal pacing showed significantly wider paced QRS than septal pacing (180±20 vs 166±12 ms; p<0.0001). Compared with septal placement, non-septal implantation was associated with lower female prevalence (15% vs 43%; p<0.001), greater RV height (78±13.6 vs 70±12.2 mm; p<0.01), and increased distance from the tricuspid annulus to device tip (33±11.8 vs 25±12.3 mm; p<0.01) (Table 1). Conclusion Nearly half of LPM implants exhibited misclassification of device position when compared with CT. Non-septal and free wall placement were common and showed a substantially wider paced QRS, supporting the need for improved intraprocedural spatial guidance. Selective integration of advanced imaging may enhance localization accuracy and optimize LPM outcomes.
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Abdelsayed et al. (2026) conducted an observational in Leadless pacemaker implantation (n=92). CT-verified non-septal leadless pacemaker placement vs. CT-verified septal leadless pacemaker placement was evaluated on Paced QRS duration (ms) and ≥1-segment discordance between procedure note and CT location (p=<0.0001). Leadless pacemaker implantation showed 42.5% discordance between procedure notes and CT, with non-septal placement yielding wider paced QRS than septal (180 vs 166 ms; p<0.0001).
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