3 years ago

Prognostic Impact of Lead Tip Position Confirmed via Computed Tomography in Patients with Right Ventricular Septal Pacing

Masayuki Hattori, Yoshihisa Naruse, Yasushi Oginosawa, Yuya Matsue, Yuichi Hanaki, Shinya Kowase, Kenji Kurosaki, Akira Mizukami, Ritsuko Kohno, Haruhiko Abe, Kazutaka Aonuma, Akihiko Nogami

Publication date: Available online 8 January 2019

Source: Heart Rhythm

Author(s): Masayuki Hattori, Yoshihisa Naruse, Yasushi Oginosawa, Yuya Matsue, Yuichi Hanaki, Shinya Kowase, Kenji Kurosaki, Akira Mizukami, Ritsuko Kohno, Haruhiko Abe, Kazutaka Aonuma, Akihiko Nogami

Abstract
Background

Although fluoroscopy-guided right ventricular (RV) lead placement in the ventricular septum is a widely performed procedure, variation in true RV lead tip position confirmed via computed tomography (CT) and its prognostic implications in patients with atrioventricular block (AVB) are not well understood.

Objective

We sought to evaluate the prognostic impact of CT-confirmed RV lead tip position.

Methods

We retrospectively enrolled 228 consecutive patients (77 ± 10 years; 125 men) with AVB who underwent fluoroscopy-guided RV septal lead implantation and thoracic CT after pacemaker implantation. Patients were classified septal and free-wall groups according to RV lead tip position. The primary endpoint was the composite outcome of cardiac death and heart failure hospitalization.

Results

The RV lead tip was located at the free wall in 18 (8%) patients. The primary endpoint occurred in 37 (16%) patients over a median follow-up period of 41 months. ECG analysis found that R amplitude in lead I of > 0.53 mV was significantly predictive of free-wall pacing with a sensitivity of 70% and specificity of 77%. Multivariate Cox regression analysis demonstrated that the lead tip in the free-wall (hazard ratio: 2.93, 95% confidence interval: 1.21–7.11, P = 0.018) was an independent predictor of the primary endpoint.

Conclusions

Fluoroscopy-guided RV lead placement carries potential risk of unexpected RV free-wall pacing and may increase the risk of cardiac death and heart failure-related hospitalization in patients undergoing RV septal pacing due to AVB and receiving thoracic CT for medical reasons.

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