- 76-year-old man
- syncope, complete atrio-ventricular block, atrial fibrillation
- single-chamber pacemaker
- chest X-ray 1 day after implantation
Chest X-ray: antero-posterior view
- right ventricular placed via the left cephalic vein
- the RV lead is directed inferiorly through the right atrium and the tricuspid valve with the tip at the right ventricular apex
Chest X-ray: lateral view (same patient)
- the tip of the right ventricular lead is antero-apical
Now look at the chest X-rays of two other patients with a dual chamber pacemaker.
right ventricular pacing site
Time limit: 0
0 of 2 Questions completed
You have already completed the case before. Hence you can not start it again.
Case is loading…
You must sign in or sign up to start the case.
You must first complete the following:
Case complete. Results are being recorded.
0 of 2 Questions answered correctly
Time has elapsed
- the right ventricular apex has been the standard pacing site since the original descriptions of permanent pacing
- the deleterious effects of long-term right ventricular apical pacing have increasingly been documented in the literature with demonstration of an association between apical pacing and left ventricular systolic dysfunction, adverse ultra-structural myocardial mechanics, deteriorated left ventricular remodeling and metabolism, atrial fibrillation as well as impaired mortality and morbidity
- these adverse effects have led to further investigation of alternate right ventricular pacing sites to better mimic normal physiology; the alternatives to the apex within the right ventricle include the outflow tract (RVOT), the mid-septum, the lower septum and, more recently, the His-bundle
- a combination of at least two well-penetrated chest radiographic views (antero-posterior and lateral views) is required to evaluate the exact ventricular lead tip location; despite the use of orthogonal planes, it is sometimes difficult to appreciate the complex right ventricular anatomy by radiography
- the right ventricular outflow tract (RVOT) is surrounded by the pulmonic valve above, the upper roof of the tricuspid valve below, the septum posteriorly and the RV free wall anteriorly; pacing is usually performed in the lower part of this area on the septal side (low septal RVOT); the infundibular region is too thin with too high pacing thresholds to be considered as a suitable target zone for pacing purposes
- mid-septal area has also experienced growing popularity due to the ease of lead implantation and stability; furthermore, pacing from this area could theoretically recreate a more physiological activation pattern
- Review / Skip