© 2002 by European Society of Cardiology
Testing a new mechanism for left interventricular septal pacing: the transseptal route
A feasibility and safety study
1Ziekenhuis Bernhoven, Veghel Radboud, The Netherlands; 2De Heel, Zaans Medisch Centrum Radboud, The Netherlands; 3Biotronik Nederland BV Radboud, The Netherlands; 4Universitair Medisch Centrum Nijmegen Radboud, The Netherlands
AIMS: To prove the feasibility and safety of left interventricular septal pacing.
BACKGROUND: Right ventricular apical pacing is an established but haemodynamically less favourable pacing method compared with transvenous left ventricular pacing. Alternatively, we propose a simple septal screw-in lead for left interventricular septal pacing.
METHODS: A pacemaker lead with a long insulated screw with the two distal windings forming an active tip was implanted from the right side of the interventricular septum to the subendocardial left side in six goats. A special guiding sheath enabled stable, easy, and swift implantation of the lead. The implantation was performed using fluoroscopy together with, normal and contrast echocardiography (via the long pre-shaped sheath) and electrocardiographic signals (His-bundle recordings in conjunction with atrial and ventricular intracardiac signals). The screw was also positioned at other locations along the free wall, and at the interventricular septum to assess possible adverse effects at other sites.
RESULTS: An average of 2.2±1.5 positions per goat was attempted. No adverse effects were noticed during implantation or at necropsy. In two goats, the final position was at the junction of the right ventricular wall and the interventricular septum. Parameters at the final positions were as follows: the pacing threshold was 1.3±1.0 V at 0.5 ms; the pacing impedance was 1022±463 
at 4.8 V and 0.5 ms. R-wave amplitudes were 17.6±7.6 mV.
CONCLUSION: Left interventricular septal pacing is feasible. In our study it was safely performed in six goats. The pacing threshold was low, and the stability of the lead system was good. Implantations in humans and animals and haemodynamic evaluations are needed to reveal the potential benefits of this new form of left interventricular septal pacing.
Key Words: Left interventricular septal screw, feasibility and safety study, transseptal pacing, pacing for congestive heart failure
Correspondence: Dr Jan C. J. Res, De Heel, Zaans Medisch Centrum, PO Box 210, 1500 EE Zaandam, The Netherlands. E-mail: janres{at}quicknet.nl
[1] Leclercq F, Hager FX, Macia JC, et al. Left ventricular lead insertion using a modified transseptal catheterization technique: a totally endocardial approach for permanent biventricular pacing in end-stage heart failure. Pacing Clin Electrophysiol 1999; 22: 1570–1575.
[2] Gold MR and Rashba EJ. Left ventricular endocardial pacing: don't try this at home. Pacing Clin Electrophysiol 1999; 22: 1567–1569.
[3] Ritter P, Gras D, Paul V, Daubert JC. Acute electrical performance of the left ventricular leads implanted in the controlled Mustic trial. Europace 2000; 1:Suppl, D39 (Abstr).
[4] Daubert JC, Ritter P, Le Breton H, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998; 21: 239–245.
[5] Gras D, Mabo P, Ritter P, et al. Permanent left ventricular pacing via coronary sinus leads: early results and long term follow up. Arch Mal Coeur Vaiss 1998; 91: 245 (Abstr).
[6] Rosenqvist M, Isaaz K, Botvinick EH, et al. Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function. Am J Cardiol 1991; 67: 148–156.
[7] Burkhoff D, Oikawa RY, Sagawa K. Influence of pacing site on canine left ventricular contraction. Am J Physiol 1986; 251: H428–H435.
[8] Lister JW, Klotz KH, Jomain SL, et al. Effect of pacemaker site on cardiac output and ventricular activation in dogs with complete heart block. Am J Cardiol 1964; 14: 494–503.
[9] Takagi Y, Dumpis Y, Usui A, et al. Effects of proximal ventricular septal pacing on hemodynamics and ventricular activation. Pacing Clin Electrophysiol 1999; 22: 1777–1781.
[10] Deshmukh P, Casavant DA, Romanyshyn M, et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000; 101: 869–877.
[11] Xiao HB, Brecker SJ, Gibson DG. Differing effects of right ventricular pacing and left bundle branch block on left ventricular function. Br Heart J 1993; 69: 166–173.
[12] Stellbrink C, Auricchio C, Diem B, et al. Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrhythmia. Am J Cardiol 1999; 83: 143D–150D.
[13] Miyizawa K, Haneda T, Shirato K, et al. Cineventriculographic analysis of the ventricular septum motion during stimulation at various pacemaker sites. Tohoku J Exp Med 1978; 126: 363–369.
[14] Badke FR, Boinay P, Covell JW. Effects of ventricular pacing on regional left ventricular performance in the dog. Am J Physiol 1980; 238: H858–867.
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