Journal of Arrhythmia (Dec 2021)

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

  • Jayaprakash Shenthar,
  • Sanjai P. Valappil,
  • Maneesh K. Rai,
  • Bharatraj Banavalikar,
  • Deepak Padmanabhan,
  • Tammo Delhaas

DOI
https://doi.org/10.1002/joa3.12636
Journal volume & issue
Vol. 37, no. 6
pp. 1512 – 1521

Abstract

Read online

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%, P = .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.

Keywords