Angiography-guided Mid/high Septal Implantation of Ventricular Leads in Patients with Congenital Heart Disease

Overview

Journal J Arrhythm

Publisher Wiley

Date 2021 Dec 10

PMID 34887956

Citations 1

Authors

Jayaprakash Shenthar

Sanjai P Valappil

Maneesh K Rai

Bharatraj Banavalikar

Deepak Padmanabhan

Tammo Delhaas

Affiliations

Soon will be listed here.

Abstract

Background: Conduction system pacing prevents pacing-induced cardiomyopathy, but it can be challenging to perform in patients with congenital heart disease (CHD), and mid/high septal lead implantation is an alternative. This study aimed to assess intraprocedural angiography's utility as a guide for mid/high-septal lead implantation in CHD patients.

Methods: The study subjects were CHD patients with Class I/IIa indications for permanent pacemaker implantation. To guide septal lead implantation, we performed an intraprocedural right ventricular angiogram in anteroposterior, 40° left anterior oblique, and 30° right anterior oblique. The primary endpoint was the lead tip in the mid/high septum on computed tomography (CT). The secondary endpoints were complications and systemic ventricular function on follow-up.

Results: From January 2008 to December 2018, we enrolled 27 patients (mean age: 30 ± 20 years; M:F 17:10) with CHD (unoperated: 20, operated: 7). The mean paced QRS duration was 131.7 ± 5.8 ms, and CT done in 22/27 patients confirmed the lead tip in the mid-septum in 16, high septum in 5, and apical septum in 1 patient. There were no procedural complications, and during a mean follow-up of 58 ± 35.2 months, there was no significant change in the systemic ventricular ejection fraction (56.4 ± 8.3% vs 53.9 + 5.9%, = .08). Two patients with Eisenmenger syndrome died because of refractory heart failure.

Conclusions: Intraprocedural angiography is safe and useful to guide mid/high-septal lead implantation in CHD patients. Mid/high septal lead position preserves systemic ventricular function in patients with CHD during medium-term follow-up.

Citing Articles

Angiography-guided mid/high septal implantation of ventricular leads in patients with congenital heart disease.

Shenthar J, Valappil S, Rai M, Banavalikar B, Padmanabhan D, Delhaas T J Arrhythm. 2021; 37(6):1512-1521.

PMID: 34887956 PMC: 8637100. DOI: 10.1002/joa3.12636.

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