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Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
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Alternate site right ventricular pacing: defining template scoring.

Harry G Mond1, Alexander Feldman, Saurabh Kumar

  • 1Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. hmond@bigpond.net.au

Pacing and Clinical Electrophysiology : PACE
|May 25, 2011
PubMed
Summary

Septal pacing sites may improve left ventricular (LV) function. This study found that altering lead placement in the right ventricle (RV) changes lead attachment angle but often maintains the same template score, suggesting potential for improved pacing strategies.

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Published on: January 31, 2019

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Prolonged right ventricular (RV) apical pacing can cause left ventricular (LV) dysfunction due to dysynchronous contraction.
  • Septal pacing sites are hypothesized to promote more synchronous LV activation compared to apical pacing.

Purpose of the Study:

  • To evaluate alternate RV pacing sites using a template scoring system.
  • To assess the effect of lead loop alteration on RV lead attachment angle in the 40° left anterior oblique (LAO) fluoroscopic view.

Main Methods:

  • Twenty-three patients undergoing RV pacing were enrolled.
  • Active fixation leads were positioned in the RV outflow tract (RVOT) or mid-RV using a septal stylet.
  • LAO cine fluoroscopy was used to measure the change in lead attachment angle with increased lead loop within the RV.

Main Results:

  • Successful lead placement was achieved in the RVOT septum (18 patients) and mid-RV septum (5 patients).
  • Increasing lead loop altered the attachment angle by 6°-32° (mean 14.6° ± 6.6°).
  • In 87% of patients, the lead placement remained within the same template score zone.

Conclusions:

  • Altering the RV lead loop changes the angle of attachment.
  • In most cases, the template score remains consistent despite changes in lead loop and angle.
  • Further research is needed to validate the accuracy and efficacy of these RV pacing templates.