Usefulness of delivery catheter on accurate right ventricular septal pacing: Mt FUJI trial. Issue 4 (16th February 2023)

• Record Type: Journal Article
• Authors: Naruse, Yoshihisa; Sano, Makoto; Kurebayashi, Nobutake; Morikawa, Shuji; Tsurumi, Naoki; Shiozawa, Tomoyuki; Takano, Shintaro; Ogano, Michio; Kimura, Kei; Miyajima, Keisuke; Sugiura, Ryo; Henmi, Ryuta; Muto, Masahiro; Hosoya, Natsuko; Hasebe, Hideyuki; Mizukami, Akira; Iguchi, Keisuke; Atsumi, Akiko; Odagiri, Keiichi; Kiyama, Yumi; Maekawa, Yuichiro
• Is Part Of: Europace. Volume 25:Issue 4(2023)
• Page Start: 1451
• Page End: 1457
• Publication Date: 2023-02-16
• Subjects: Pacemaker -- Atrioventricular block -- Right ventricular septal pacing -- Delivery catheter -- Stylet; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euad027
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Although the delivery catheter system for pacemaker-lead implantation is a new alternative to the stylet system, no randomized controlled trial has addressed the difference in right ventricular (RV) lead placement accuracy to the septum between the stylet and the delivery catheter systems. This multicentre prospective randomized controlled trial aimed to prove the efficacy of the delivery catheter system for accurate delivery of RV lead to the septum. Methods and results: In this trial, 70 patients (mean age 78 ± 11 years; 30 men) with pacemaker indications of atrioventricular block were randomized to the delivery catheter or the stylet groups. Right ventricular lead tip positions were assessed using cardiac computed tomography within 4 weeks of pacemaker implantation. Lead tip positions were classified into RV septum, anterior/posterior edge of the RV septal wall, and RV free wall. The primary endpoint was the success rate of RV lead tip placement to the RV septum. Results: Right ventricular leads were implanted as per allocation in all patients. The delivery catheter group had higher success rate of RV lead deployment to the septum (78 vs. 50%; P = 0.024) and narrower paced QRS width (130 ± 19 vs. 142 ± 15 ms P = 0.004) than those in the stylet group. However, there was no significant difference in procedure time [91 (IQR 68–119) vs. 85 (59–118) min; P = 0.488] or the incidence of RV lead dislodgment (0 vs. 3%; P = 0.486). Conclusion: The delivery catheter system can achieve a higher success rate of RV lead placement to the RV septum and narrower paced QRS width than the stylet system. Trial registration number: jRCTs042200014 (https://jrct.niph.go.jp/en-latest-detail/jRCTs042200014 ) Graphical Abstract: Graphical Abstract Outcome comparison between delivery catheter and stylet systems. The delivery catheter system can achieve a higher RV lead placement on the RV septum success rate and a narrower paced QRS width than the stylet system. RV, right ventricular.