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Pacing from the right ventricular septum: is there a danger to the coronary arteries?

Andrew W Teh1, Caroline Medi, Raphael Rosso

  • 1Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.

Pacing and Clinical Electrophysiology : PACE
|July 4, 2009
PubMed

Insights

Right ventricular septal pacing avoids coronary artery compromise. Septal lead placement is safer than apical pacing, preventing potential issues with the left anterior descending coronary artery.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Right ventricular (RV) apical pacing may negatively impact left ventricular function.
  • RV septal pacing is explored as an alternative to mitigate these effects.
  • Potential proximity of pacing leads to the left anterior descending coronary artery (LAD) is a concern.

Observation:

  • A retrospective analysis of three patients with RV active-fixation leads and coronary angiography was performed.
  • Fluoroscopic views assessed the relationship between lead tips and coronary arteries.
  • Lead placement on the anterior wall showed close proximity to the LAD.

Findings:

  • RV septal lead placement demonstrated no compromise of coronary arteries.
  • RV free wall positioning also appeared safe regarding coronary artery proximity.

Implications:

  • Septal positioning of RV active-fixation leads is a safe strategy.
  • This approach avoids potential complications associated with LAD compromise.
  • Septal pacing offers a potentially safer alternative for long-term cardiac pacing.
Abstract

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