Paced QRS Duration and Morphology by Right Ventricular Inflow Tract Mid-Septal Lead Placement Using a 3D Stylet

Paced QRS duration ≥150 ms is associated with pacing-induced cardiomyopathy (PICM). However, there is no established method for conventional stylet-driven pacing lead placement to achieve a narrow QRS duration. We placed a pacing lead on the right ventricular inflow tract (RVIT) mid-septum using a manually shaped three-dimensional (3D) stylet and three-directional fluoroscopic guidance in 9 consecutive patients with complete or advanced atrioventricular block and normal left ventricular systolic function. The median paced QRS duration was 140 (range, 122-153) ms, with a paced QRS duration <150 ms in 8 patients. The left superior axis and transitional zone of lead-V5 or lead-V6 were the most paced QRS morphologies. RVIT mid-septal lead placement using a 3D stylet with three-directional fluoroscopic guidance may reduce the incidence of PICM.