Efficacy of Delivery Catheter for the Right Ventricular Septal Placement of a Defibrillator Lead

Right ventricular (RV) septal placement of implantable cardioverter-defibrillator (ICD) leads has been proposed as an alternative to conventional apical placement. However, optimal techniques for accurate septal defibrillator lead implantation remain to be established.

This single-center, retrospective study analyzed 37 patients with cardiomyopathy who underwent ICD implantation with intended RV septal defibrillator lead placement. Patients were categorized into two groups based on the implantation technique: delivery catheter (n = 7) or stylet system (n = 30). Myocardial current of injury (COI) monitoring was used in the delivery catheter group to guide lead fixation. The lead position was assessed by cardiac computed tomography, and procedural outcomes were compared.

Accurate RV septal lead placement was achieved in 100% of the delivery catheter group compared to 60% in the stylet group (p = 0.047). The delivery catheter group also demonstrated significantly shorter lead implantation time (median 9 vs. 17 min, p = 0.016) and total fluoroscopy time (median 15 vs. 29 min, p = 0.009). Lead parameters and complication rates were comparable. A subclinical pericardial effusion was identified in one patient from the stylet group, in whom the lead was positioned in the RV free wall.

The use of the delivery catheter with COI monitoring significantly enhanced the accuracy and efficiency of RV septal defibrillator lead implantation without compromising safety. This technique may offer procedural advantages over conventional stylet-based methods in patients with cardiomyopathy. Prospective studies are needed to establish more definitively the usefulness and safety of this approach.