A technique of lead insertion for low atrial septal pacing

Pacing in the low right atrial septum (LAS) appears superior to right atrial appendage or free wall stimulation for the prevention of paroxysmal atrial fibrillation. However, insertion of active fixation lead in the low right atrial septal position is difficult and time consuming, inhibiting application of this pacing method in daily practice.

The technique of handling and positioning of a new "over the wire" lead system is presented with emphasis on electrocardiographic P wave pattern and fluoroscopic landmarks.

The initial results demonstrate an acute implantation and short-term success of LAS pacing of >90% in the first 100 patients without major complications. Pacing thresholds at 3 and 6 months were fully comparable with that of the conventional atrial pacing, whereas impedance and atrial sensing signals were significantly higher at 3 and 6 months follow-up.

These favorable initial results justify recommanding chronic LAS pacing with the active fixation atrial lead and providinge guidelines and fluoroscopic landmarks for the implantation. Insertion of the atrial active fixation lead positioned with the Locatortrade mark tool strongly supports the implantation procedure.