*Correspondence author:
Baopeng Tang, PhD, (Email: tangbaopeng1111@163.com)
Department of Pacing and Electrophysiology, The First Affiliated
Hospital of Xinjiang Medical University, No.137, South Liyushan Road,
Xinshi Zone, Urumqi, Xinjiang, China. Tel: +86
0991-4366852.
ABSTRACT
Background:Implanting leadless pacemakers in the right ventricular (RV) apex is
prone to causing pericardial tamponade and myocardial perforation.
Objective: To investigate the feasibility and safety of right
ventriculography-guided implantation of MicraTMleadless pacemaker (Micra) in the RV mid-septum.
Methods: 108 consecutive patients who underwent Micra
implantation intended in the mid-septum were enrolled and randomized
(3:1) into the radiography group (n=81) with assistance of right
ventriculography to illustrate the RV septum and the non-radiography
group (n=27). All subjects underwent a postoperative computed tomography
(CT) scan to determine the Micra location. The Micra location assessed
by CT image was compared between the two groups to confirm the accuracy
of the intended pacing site. The duration of the procedure, X-ray
exposure dose and time were also compared between the two groups.
Results: Reconstructed CT 3-D cardiac imaging found the Micra
location in the intended mid-septum in 13 patients (48.1%, 13/27) in
the non-radiography group and 76 patients (93.8%, 76/81) in the
radiography group (P < 0.0001 between two groups). There
was no significant difference in procedure interval between the two
groups while the X-ray exposure (564.86±112.44 vs. 825.85±156.12mGy, P
< 0.0001), X-ray exposure time (7.79±1.43vs. 12.03±2.86 min, P
< 0.0001) and the number of fluoroscopy re-positioning
(2.79±1.03, vs. 6.41±1.82, P<0.0001) were significantly less
in the radiography group than in the non-radiography group. No
implantation-related complications were observed in both groups.
Conclusion Right ventriculography increases the accuracy of
MicraTM pacemaker implantation in the mid-septum and
reduces X-ray exposure.
Keywords MicraTM leadless pacemaker, right
ventriculography, right ventricular septum, cardiac computed tomography,
implantation
Funding: National Natural Science Foundation of China (Grant
number:81873487) awarded to Yaodong Li.