Impact of Leadless Pacemaker Implantation Position on Subclinical Right Ventricular Perforation

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Leadless pacemakers are implanted in the right ventricle (RV) to minimize perforation risk.
• Precise leadless pacemaker implant locations are not well-documented.
• This study investigates leadless pacemaker positioning and subclinical perforation using CT imaging.

Purpose of the Study:

• To determine the common implantation sites of leadless pacemakers.
• To assess the incidence of subclinical right ventricular (RV) perforation.
• To evaluate the prognosis associated with subclinical RV perforation.

Main Methods:

• Retrospective analysis of CT scans from 88 patients post-leadless pacemaker implantation.
• Two cardiologists and one radiologist assessed leadless pacemaker tine position and RV perforation.
• Implantation sites categorized: septum, RV free wall, junction, moderator band, RV apex. Subclinical perforation defined as tines outside myocardial contour without adverse events.

Main Results:

• The junction of the septum and RV free wall was the most common implantation site (77.3%).
• Subclinical RV perforation occurred in 17.0% of patients.
• No adverse events were observed in patients with subclinical RV perforation over a 12.4-month follow-up.

Conclusions:

• The junction of the septum and RV free wall is the predominant site for leadless pacemaker implantation.
• Subclinical RV perforation is a frequent finding.
• Subclinical RV perforation does not appear to be associated with adverse clinical outcomes.