- 76-year-old woman
- syncope and complete atrio-ventricular block
- dual-chamber pacemaker
- chest X-ray 1 day after implantation
Chest X-ray: antero-posterior view
- right atrial lead placed via the left subclavian vein
- the right atrial lead is directed inferiorly and takes a J loop curve with the tip at the right atrial appendage
Now let’s see two other patients.
right atrial pacing site
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- the conventional site for atrial pacing is the right atrial appendage because it is an easily accessible and stable location
- when the atrial lead is positioned at the appendage, the chest X-ray shows an inferiorly directed lead into the right atrium, with an anterior curve (“J loop”)
- pacing from the right atrial appendage in patients with pathological atrial myocardium prolongs the intra-atrial/inter-atrial conduction time and may increase the risk of atrial fibrillation
- alternative pacing sites within the right atrium (Bachmann’s bundle, interatrial septum, ostium of the coronary sinus or multiple atrial sites) have been investigated to prevent the occurrence of atrial fibrillation
- despite initial promising results with significant reduction of the total atrial activation time, the value of septal pacing or biatrial pacing in preventing atrial fibrillation has not been clearly demonstrated
- the lateral atrial wall is usually avoided because of the increased risk of perforation and of phrenic nerve capture
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