Actual conditions of atrial septal lead implantation and the factors related to successful implantation

Taro Narumi; Yoshihisa Naruse; Keisuke Miyajima; Yutaro Kaneko; Makoto Sano; Yuichiro Maekawa

doi:10.1016/j.jjcc.2023.04.009

Actual conditions of atrial septal lead implantation and the factors related to successful implantation

J Cardiol. 2023 Nov;82(5):371-377. doi: 10.1016/j.jjcc.2023.04.009. Epub 2023 Apr 24.

Authors

Taro Narumi¹, Yoshihisa Naruse², Keisuke Miyajima³, Yutaro Kaneko¹, Makoto Sano¹, Yuichiro Maekawa¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
² Division of Cardiology, Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: ynaruse@hama-med.ac.jp.
³ Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan.

PMID: 37100387
DOI: 10.1016/j.jjcc.2023.04.009

Abstract

Background: Pacemaker leads were originally implanted into the right atrial appendage (RAA) and right ventricular apex, but septal pacing, which is more physiological, is becoming increasingly popular. The usefulness of atrial lead implantation in the RAA or atrial septum is inconclusive, and whether or not atrial septum implantation is accurate has not yet been verified.

Methods: Patients who underwent pacemaker implantation between January 2016 and December 2020 were included. The success rate of atrial septal implantation was validated using thoracic computed tomography performed for any reason postoperatively. We examined factors related to the successful implantation of the atrial lead in the atrial septum.

Results: Forty-eight people were included in this study. Lead placement was performed with a delivery catheter system (SelectSecure MRI SureScan; Medtronic Japan Co., Ltd., Tokyo, Japan) in 29 cases and a conventional stylet in 19 cases. The mean age was 74 ± 12 years old, and 28 (58%) were male. Successful atrial septal implantation was performed in 26 patients (54%), with only 4 (21%) successful implantations in the stylet group. There were no significant differences in the age, gender, body mass index (BMI), pacing P wave axis, duration, or amplitude between the atrial septal implantation group and non-septal groups. The only significant difference was for delivery catheter use [22 (85%) vs. 7 (32%), p < 0.001]. In multivariate logistic analysis, the use of a delivery catheter was independently associated with successful septal implantation [odds ratio (OR): 16.9, 95% confidence interval 3.0-90.9] after adjusting for the age, gender, and BMI.

Conclusion: The success rate of atrial septal implantation was very low at 54%, and only the use of a delivery catheter was associated with successful septal implantation. However, even with a delivery catheter, the success rate was 76%, so further investigations are warranted.

Keywords: Atrial septum; Delivery Catheter system; Pacemaker.

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation*
Atrial Septum*
Cardiac Pacing, Artificial
Female
Heart Septal Defects, Atrial*
Humans
Male
Middle Aged
Pacemaker, Artificial*