Selective site pacing: tools and training.

Current tools and techniques for pacemaker and ICD lead insertion have been optimized for implantation of leads at traditional sites but may be ill-suited for achieving alternate or selective site placement. If clinical studies confirm that optimal pacing is achieved from locations other than the right atrial appendage and right ventricular apex, new tools for reliably, easily and safely implanting leads at these sites will need to be created and methods for identifying these optimal pacing site(s) in each patient will be needed. Implant centers will need to understand the benefits of selective site pacing and make the transition to using these new tools. The various factors affecting the change from traditional to selective site pacing lead placement are discussed.