Masayuki Hattori1, Yoshihisa Naruse2, Yasushi Oginosawa3, Yuya Matsue4, Yuichi Hanaki5, Shinya Kowase1, Kenji Kurosaki1, Akira Mizukami4, Ritsuko Kohno6, Haruhiko Abe6, Kazutaka Aonuma5, Akihiko Nogami5. 1. Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan. 2. Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan. Electronic address: ynaruse@hama-med.ac.jp. 3. Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 4. Department of Cardiology, Kameda Medical Center, Kamogawa, Japan. 5. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 6. Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan.
Abstract
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.
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.