title: Placement of a pacing lead at the inferior portion of the interatrial septum without special tools.
abstract: BACKGROUND
  Previous studies have suggested that, among septal sites, the inferior portion of the interatrial septum (IAS) is the most likely to prevent atrial fibrillation, though inserting an active fixation lead at this site can be tedious and time consuming. We describe a relatively straightforward technique to insert a lead at this site without special tools.
  
  
  METHODS
  We studied 117 consecutive patients (mean age = 76 +/- 8 years, 69% men) with ACC/AHA class I and II pacing indications and histories of paroxysmal or permanent atrial fibrillation, undergoing implantation of a dual chamber pacing system. A technique using the "preshaped" stylet and fluoroscopic guidance is described.
  
  
  RESULTS
  The insertion was successful in 111 patients (95%). Acute dislodgement occurred in six patients (5%). The intrinsic P-wave duration was 117 +/- 22 ms, and the paced P-wave duration was 90 +/- 20 ms (23% shortening, P < 0.001). The mean time required to insert the atrial lead was 12 +/- 8 minutes. No complications occurred.
  
  
  CONCLUSIONS
  Insertion of an active fixation lead at the inferior portion of the interatrial septum was safe and highly successful in the majority of patients with this technique.
authors.affiliation: Trinity Medical Center, Rock Island, Illinois, USA. acosta@cvmedpc.com
authors.forename: Helbert
authors.initials: H
authors.lastname: Acosta
authors.forename: Vijayasimha R
authors.initials: VR
authors.lastname: Pothula
authors.forename: Mario
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Sumati
authors.initials: S
authors.lastname: Ramadas
authors.forename: Agustin
authors.initials: A
authors.lastname: Castellanos
mesh_terms: D001281:Atrial Fibrillation / Q000517:prevention & control / Q000628:therapy*; D054087:Atrial Septum; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006801:Humans; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods