Generic placeholder image

Current Medical Imaging

Author(s): Zhan Hong Wang, HongGuang Miao, Wei Qin Wang, SiYao Kang, HaiYing Jin, Dong Ting Liu* and Jun Meng Zhang*

DOI: 10.2174/1573405619666230216092351

DownloadDownload PDF Flyer Cite As
Cardiac Computed Tomography to Guide the Selection of Better Display Angle of Cardiac Right Ventricular Pacing Electrode in Radiography

Article ID: e160223213710 Pages: 8

  • * (Excluding Mailing and Handling)

Explore Articles
About Journal
For Authors
For Editors
For Reviewers

Abstract

Background: Traditional radiography angles do not adequately reveal the shape and position of the right ventricular pacing electrode.

Objective: This study aimed to explore better radiography angles with the help of cardiac computed tomography (CT).

Methods: We analyzed the cardiac CT images of consecutive outpatients from 2018 to 2019. The right anterior oblique (RAO) 30° and the left anterior oblique (LAO) 40° were found to sufficiently display the shape and position of the right ventricular pacing electrode.

Results: A total of 214 consecutive outpatients were enrolled, whose average age was 55.0 ± 13.0 years, and 151 were male (70.6%). Through analyzing the cardiac CT images, the α angle (33.7° ± 6.1) and the γ angle (38.8° ± 8.0) were determined. Furthermore, we verified these angles in 48 patients after pacemaker implantation. The results showed that the ratio of the length of right ventricular electrode using the RAO α angle (≈30°) to the posterior-anterior position (PA position) was 1.099 ± 0.157 vs. 1.053 ± 0.182 (the ratio using the traditional RAO 45°) (P < 0.001). We observed that the relationship between the right ventricular active electrode and the ventricular septum was better identified using the LAO γ angle (≈40°) than the traditional 60° angle.

Conclusion: With the help of cardiac CT, we found that RAO 30° could better show the shape and length of the right ventricular pacing electrode, and LAO 40° could better show the positional relationship between the pacing electrode and the ventricular septum.

Keywords: Cardiac pacing, right ventricular lead position, computer tomography, lead position, RAO, LAO.

Graphical Abstract

[1]
Steiner RM, Tegtmeyer CJ, Morse D, et al. The radiology of cardiac pacemakers. Radiographics 1986; 6(3): 373-99.
[http://dx.doi.org/10.1148/radiographics.6.3.3317544] [PMID: 3317544]
[2]
Brixey AG, Fuss C. Innovative cardiac devices on chest imaging: An update. J Thorac Imaging 2017; 32(6): 343-57.
[http://dx.doi.org/10.1097/RTI.0000000000000304] [PMID: 29065008]
[3]
Squara F, Fourrier E, Diascorn Y, et al. Cardiac anatomical axes by CT scan and confirmation of the accuracy of fluoroscopic individualized left anterior oblique projection for right ventricular lead implantation. J Interv Card Electrophysiol 2021; 60(2): 213-9.
[http://dx.doi.org/10.1007/s10840-020-00729-7] [PMID: 32219588]
[4]
Patel D, Sripariwuth A, Abozeed M, et al. Lead location as assessed on cardiac computed tomography and difficulty of percutaneous transvenous extraction. JACC Clin Electrophysiol 2019; 5(12): 1432-8.
[http://dx.doi.org/10.1016/j.jacep.2019.07.018] [PMID: 31857043]
[5]
Hattori M, Naruse Y, Oginosawa Y, et al. Prognostic impact of lead tip position confirmed via computed tomography in patients with right ventricular septal pacing. Heart Rhythm 2019; 16(6): 921-7.
[http://dx.doi.org/10.1016/j.hrthm.2019.01.008] [PMID: 30633981]
[6]
Naruse Y, Miyajima K, Sugiura R, et al. Comparison of delivery catheter-based and stylet-based right ventricular lead placement at the right ventricular septum under fluoroscopic guidance judged by cardiac CT (Mt. FUJI): A study protocol for the Mt. FUJI randomised controlled trial. BMJ Open 2021; 11(5): e046782.
[http://dx.doi.org/10.1136/bmjopen-2020-046782] [PMID: 34039576]
[7]
Modi S, Yee R, Scholl D, et al. Ventricular pacing site separation by cardiac computed tomography: Validation for the prediction of clinical response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 2017; 33(9): 1433-42.
[http://dx.doi.org/10.1007/s10554-017-1120-4] [PMID: 28357725]
[8]
Moore P, Coucher J, Ngai S, et al. Imaging and right ventricular pacing lead position: A comparison of CT, MRI, and echocardiography. Pacing Clin Electrophysiol 2016; 39(4): 382-92.
[http://dx.doi.org/10.1111/pace.12817] [PMID: 26769293]
[9]
Sommer A, Kronborg MB, Witt CT, Nørgaard BL, Nielsen JC. The paced electrocardiogram cannot be used to identify left and right ventricular pacing sites in cardiac resynchronization therapy: Validation by cardiac computed tomography. Europace 2015; 17(3): 432-8.
[http://dx.doi.org/10.1093/europace/euu323] [PMID: 25480941]
[10]
Pang BJ, Joshi SB, Lui EH, et al. Validation of conventional fluoroscopic and ECG criteria for right ventricular pacemaker lead position using cardiac computed tomography. Pacing Clin Electrophysiol 2014; 37(4): 495-504.
[http://dx.doi.org/10.1111/pace.12301] [PMID: 24215477]
[11]
Philip W, Ballinger Eugene D. Merrill’s atlas of radiographic positions and radiologic procedures Louis Missouri: Andrewallen 2003; pp. 558-62.
[12]
Kathy Mcquillen Martensen. Radiographic Image analysis. Louis Missouri: Saunders 2015; pp. 110-2.
[13]
Bontrager KL, Lampignano JP. Textbook of radiographic positioning and related anatomy Louis Missouri: Mosby Elsevier 2014; pp. 96-9.
[14]
Cano Ó, Andrés A, Alonso P, et al. Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: A single-centre experience with over 3800 implanted leads. Europace 2016; 19(1): euv410.
[http://dx.doi.org/10.1093/europace/euv410] [PMID: 26847075]
[15]
Bhatia P, Chiou T, Svennberg E, et al. Clinical significance of incidentally detected lead perforations by computed tomography. Pacing Clin Electrophysiol 2021; 44(5): 936-42.
[http://dx.doi.org/10.1111/pace.14229] [PMID: 33786829]
[16]
Rajkumar CA, Claridge S, Jackson T, et al. Diagnosis and management of iatrogenic cardiac perforation caused by pacemaker and defibrillator leads. Europace 2016; 19(6): euw074.
[http://dx.doi.org/10.1093/europace/euw074] [PMID: 27353321]
[17]
Rovner A, de las Fuentes L, Faddis MN, Gleva MJ, Dávila-Román VG, Waggoner AD. Relation of left ventricular lead placement in cardiac resynchronization therapy to left ventricular reverse remodeling and to diastolic dyssynchrony. Am J Cardiol 2007; 99(2): 239-41.
[http://dx.doi.org/10.1016/j.amjcard.2006.07.086] [PMID: 17223425]
[18]
Becker M, Kramann R, Franke A, et al. Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography. Eur Heart J 2007; 28(10): 1211-20.
[http://dx.doi.org/10.1093/eurheartj/ehm034] [PMID: 17426079]
[19]
Witt CM, Lenz CJ, Shih HH, et al. Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. J Cardiovasc Electrophysiol 2017; 28(8): 924-30.
[http://dx.doi.org/10.1111/jce.13256] [PMID: 28543771]
[20]
Döring M, Müssigbrodt A, Ebert M, et al. Transvenous revision of leads with cardiac perforation following device implantation-Safety, outcome, and complications. PACE 2020; 43(11): 1325-32.
[http://dx.doi.org/10.1111/pace.14056]
[21]
Kusumoto FM, Schoenfeld MH, Barrett C, et al. ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A report of the American College of Cardiology/American heart association Task force on clinical practice guidelines and the heart rhythm Society. Circulation 2019; 140(8): e382-482.
[http://dx.doi.org/10.1161/CIR.0000000000000628] [PMID: 30586772]
[22]
Biffi M, Capobianco C, Spadotto A, et al. Pacing devices to treat bradycardia: Current status and future perspectives. Expert Rev Med Devices 2021; 18(2): 161-77.
[http://dx.doi.org/10.1080/17434440.2021.1866543] [PMID: 33336616]
[23]
DeForge WF. Cardiac pacemakers: A basic review of the history and current technology. J Vet Cardiol 2019; 22: 40-50.
[http://dx.doi.org/10.1016/j.jvc.2019.01.001] [PMID: 30792165]
[24]
Kumar P, Blendea D, Nandigam V, Moore SA, Heist EK, Singh JP. Assessment of the post-implant final left ventricular lead position: A comparative study between radiographic and angiographic modalities. J Interv Card Electrophysiol 2010; 29(1): 17-22.
[http://dx.doi.org/10.1007/s10840-010-9497-1] [PMID: 20556496]
[25]
Rickard J, Ingelmo C, Sraow D, et al. Chest radiography is a poor predictor of left ventricular lead position in patients undergoing cardiac resynchronization therapy: Comparison with multidetector computed tomography. J Interv Card Electrophysiol 2011; 32(1): 59-65.
[http://dx.doi.org/10.1007/s10840-011-9586-9] [PMID: 21584784]