Related Experiment Video
Updated: Jan 30, 2026
Patient-specific Modeling of the Heart: Estimation of Ventricular Fiber Orientations
Published on: January 8, 2013
Prognostic impact of lead tip position confirmed via computed tomography in patients with right ventricular septal
Masayuki Hattori1, Yoshihisa Naruse1, Yasushi Oginosawa2
1Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan.
Background:
Although fluoroscopy-guided right ventricular (RV) lead placement in the ventricular septum is a widely performed procedure, variation in true RV lead tip position confirmed via computed tomography (CT) and its prognostic implications in patients with atrioventricular block (AVB) are not well understood.
Objective:
The purpose of this study was to evaluate the prognostic impact of CT-confirmed RV lead tip position.
Methods:
We retrospectively enrolled 228 consecutive patients (age 77 ± 10 years; 125 men) with AVB who underwent fluoroscopy-guided RV septal lead implantation and thoracic CT after pacemaker implantation. Patients were classified into septal and free-wall groups according to RV lead tip position. The primary endpoint was the composite outcome of cardiac death and heart failure hospitalization.
Results:
The RV lead tip was located at the free wall in 18 patients (8%). The primary endpoint occurred in 37 patients (16%) over median follow-up of 41 months. Electrocardiographic analysis found that R amplitude >0.53 mV in lead I was significantly predictive of free-wall pacing, with sensitivity of 70% and specificity of 77%. Multivariate Cox regression analysis demonstrated that the lead tip in the free wall (hazard ratio 2.93; 95% confidence interval 1.21-7.11; P = .018) was an independent predictor of the primary endpoint.
Conclusion:
Fluoroscopy-guided RV lead placement carries potential risk of unexpected RV free-wall pacing and may increase the risk of cardiac death and heart failure-related hospitalization in patients undergoing RV septal pacing due to AVB and receiving thoracic CT for medical reasons.
Related Concept Videos
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:27Imaging Studies III: Computed Tomography
01:31Confirmation Biases
01:19Impact of Groups on Groups
02:32Position-effect Variegation
01:30Impact
When particles with different initial velocities collide, they induce deformation by applying equal and opposite impulses. At the point of maximum deformation, the particles move together with...