Real-time echocardiographic guidance for confirming septal placement of right ventricular leads: A pilot study

Abstract

Introduction: Accuracy of fluoroscopy in predicting septal placement of the right ventricular (RV) leads is poor. This pilot study evaluated the feasibility and impact of real-time transthoracic echocardiogram (TTE) during RV lead placement. Method: Consecutive patients undergoing transvenous RV lead placement and had a point of care ultrasound team available for TTE guidance were included in the study. TTE was performed to confirm or refute the septal position of RV lead initially positioned using fluoroscopy; leads were repositioned until a septal position was confirmed on TTE. The primary outcome measured was whether the use of TTE resulted in lead repositioning. Result: Among the 26 patients included in the study, real-time TTE during RV lead placement resulted in reposition of the lead to a septal position in 38.5% of patients. Conclusion: Use of real-time TTE guidance during fluoroscopic RV lead placement is feasible and can aid in confirming a septal position.