title: Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT.
abstract: BACKGROUND
  Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12-lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG-gated multidetector contrast-enhanced computed tomography (MDCT) with the position derived from the surface 12-lead ECG.
  
  
  METHODS
  Eighteen patients with permanent RV leads were prospectively enrolled. Leads were placed in the RV septum (RVS) in 10 and the RV apex (RVA) in eight using fluoroscopy with anteroposterior and left anterior oblique 30° views. All patients underwent MDCT imaging and paced ECG analysis. ECG criteria were: QRS duration; QRS axis; positive or negative net QRS amplitude in leads I, aVL, V1, and V6; presence of notching in the inferior leads; and transition point in precordial leads at or after V4.
  
  
  RESULTS
  Of the 10 leads implanted in the RVS, computed tomography (CT) imaging revealed seven to be at the anterior RV wall, two at the anteroseptal junction, and one in the true septum. For the eight RVA leads, four were anterior, two septal, and two anteroseptal. All leads implanted in the RVS met at least one ECG criteria (median 3, range 1-6). However, no criteria were specific for septal position as judged by MDCT. Mean QRS duration was 160 ± 24 ms in the RVS group compared with 168 ± 14 ms for RVA pacing (P = 0.38).
  
  
  CONCLUSIONS
  We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT.
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Rowe
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Moore
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.
authors.forename: Jit
authors.initials: J
authors.lastname: Pratap
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Coucher
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gould
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Kaye
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D057791:Cardiac Imaging Techniques / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D054088:Ventricular Septum / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: computed tomography (CT); electrocardiogram; permanent pacing; septal pacing