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Using the Surface ECG to Identify Right Ventricular Pacing Lead Position: A Cautionary Tale.
Gerald C Kaye1,2, Matthew K Rowe1,2, Paul A Gould1,2
1Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Right ventricular apical pacing can cause heart failure. While septal pacing is an alternative, accurately confirming lead placement using electrocardiograms (ECG) remains difficult, as shown in this case study.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Chronic right ventricular apical pacing is linked to heart failure development.
- Right ventricular septal pacing is a proposed alternative to mitigate this risk.
- Accurate lead placement in the true septum is technically challenging.
Observation:
- Fluoroscopy and 12-lead surface electrocardiograms (ECG) are used to confirm lead position.
- Previous studies suggest ECG may be inaccurate for determining septal lead placement.
- A case demonstrated a late change in ECG QRS axis after pacemaker insertion.
Findings:
- The case highlights the challenges in accurately localizing pacing leads using ECG.
- Active fixation leads can present difficulties in confirming septal positioning.
- Late ECG changes may indicate lead migration or altered pacing parameters.
Implications:
- Rethinking the reliability of ECG for septal lead verification is necessary.
- Improved methods for lead placement confirmation in cardiac pacing are needed.
- Understanding lead behavior over time is crucial for preventing heart failure progression.
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