Validation of Conventional Fluoroscopic and ECG Criteria for Right Ventricular Pacemaker Lead Position Using Cardiac Computed Tomography

Citations Over TimeTop 10% of 2013 papers

Abstract

Introduction It is hypothesized that pacing the right ventricular (RV) septum is associated with less deleterious outcomes than RV apical pacing. Our aim was to validate fluoroscopic and electrocardiography (ECG) criteria for describing pacemaker and implantable cardioverter defibrillator RV “septal” lead position against the proposed gold standard: cardiac computed tomography (CT). Methods Using the conventional fluoroscopic criteria, we intended to place RV nonapical leads on the interventricular septum. Lead positions were later retrospectively analyzed with CT and correlated with ECGs and fluoroscopic projections: posterior‐anterior, 40° left anterior oblique (LAO), 40° right anterior oblique (RAO), and left lateral. Results Only 21% (nine of 35) of presumed “septal” RV nonapical leads using the conventional fluoroscopic criteria were on the true septum. A schema developed to define septal position in the RAO fluoroscopic view had high agreement with CT images. ECG criteria had only fair to moderate agreement with CT. The paced QRS duration was significantly longer (P < 0.001) with RV apical pacing (176 ± 10.7 ms), compared to RV nonapical pacing (144.5 ± 14.3 ms). Conclusion Using the conventional fluoroscopic criteria, only a minority of RV leads were implanted on the true RV septum. Instead, aiming for the middle of the cardiac silhouette in the RAO fluoroscopic view, confirming rightward orientation in the LAO view, and having a paced QRS duration <140 ms may allow the implanting cardiologist a simple, more accurate method to achieve true RV septal lead positioning.

Related Papers

• → Reduction of radiation dose in pediatric patients using pulsed fluoroscopy.(1996)120 cited
• → Patient skin dose in cardiac interventional procedures: Conventional fluoroscopy versus pulsed fluoroscopy(2006)42 cited
• → Physician Documentation of Fluoroscopy Time in Voiding Cystourethrography Reports Correlates With Lower Fluoroscopy Times: A Surrogate Marker of Patient Radiation Exposure(2011)20 cited
• → Fluoroscopy-Based Surgical Navigation versus Fluoroscopic Guidance to Control Guide Wire Insertion for Osteosynthesis of Femoral Neck Fractures(2004)3 cited
• → PO-02-141 SEEING THE HEART WITHOUT FLUOROSCOPY: ADVANCES IN AF ABLATIONS(2023)