The road to right ventricular septal pacing: techniques and tools

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Prolonged right ventricular (RV) apical pacing can lead to left ventricular dysfunction due to asynchronous activation.
• RV septal pacing offers a potentially more physiological alternative with narrower QRS durations.

Purpose of the Study:

• To review the anatomical, radiographic, and electrocardiographic aspects of RV septal lead placement.
• To detail techniques and tools for reliable RV septal lead implantation.
• To advocate for a shift from RV apical to RV septal pacing.

Main Methods:

• Review of RV septal anatomy and lead placement.
• Analysis of radiographic and electrocardiographic findings for septal leads.
• Description of active-fixation lead implantation techniques for the RV septum.

Main Results:

• Conventional active-fixation leads can be reliably implanted on the RV outflow tract or mid-septum.
• Low complication rates and good long-term performance are achievable with septal lead placement.
• Current techniques enable secure and effective RV septal lead positioning.

Conclusions:

• The detrimental effects of RV apical pacing necessitate a change in practice.
• RV septal pacing is a viable and potentially superior alternative to RV apical pacing.
• Securing all RV leads to the septum is recommended to mitigate risks of ventricular dysfunction.