Validation of Conventional Fluoroscopic and ECG Criteria for Right Ventricular Pacemaker Lead Position Using Cardiac Computed Tomography

作者：Pang Benjamin J; Joshi Subodh B; Lui Elaine H; Tacey Mark A; Ling Liang Han; Alison Jeff; Seneviratne Sujith K; Cameron James D; Mond Harry G^*

来源：Pacing and Clinical Electrophysiology, 2014, 37(4): 495-504.

DOI：10.1111/pace.12301

• fluoroscopy
• computer tomography
• pacing and ICD lead implantation
• right ventricular septum

Introduction
It is hypothesized that pacing the right ventricular (RV) septum is associated with less deleterious outcomes than RV apical pacing. Our aim was to validate fluoroscopic and electrocardiography (ECG) criteria for describing pacemaker and implantable cardioverter defibrillator RV "septal" lead position against the proposed gold standard: cardiac computed tomography (CT).
Methods
Using the conventional fluoroscopic criteria, we intended to place RV nonapical leads on the interventricular septum. Lead positions were later retrospectively analyzed with CT and correlated with ECGs and fluoroscopic projections: posterior-anterior, 40 degrees left anterior oblique (LAO), 40 degrees right anterior oblique (RAO), and left lateral.
Results
Only 21% (nine of 35) of presumed "septal" RV nonapical leads using the conventional fluoroscopic criteria were on the true septum. A schema developed to define septal position in the RAO fluoroscopic view had high agreement with CT images. ECG criteria had only fair to moderate agreement with CT. The paced QRS duration was significantly longer (P < 0.001) with RV apical pacing (176 +/- 10.7 ms), compared to RV nonapical pacing (144.5 +/- 14.3 ms).
Conclusion
Using the conventional fluoroscopic criteria, only a minority of RV leads were implanted on the true RV septum. Instead, aiming for the middle of the cardiac silhouette in the RAO fluoroscopic view, confirming rightward orientation in the LAO view, and having a paced QRS duration <140 ms may allow the implanting cardiologist a simple, more accurate method to achieve true RV septal lead positioning.

• 出版日期2014-4