Septal lead placement

Padeletti L, Purerfellner H, Adler SW, Waller TJ, Harvey M, Horvitz L, Holbrook R, Kempen K, Mugglin A, Hettrick DA. Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. J Cardiovasc Electrophysiol. 2003 14 1189-1195. 

Bennett et al. reported that atrial activation times were similar when pacing from the CS os, Bachmann s Bnndle or the interatrial septum (30). Of these three options, septal lead placement may be preferable given its relative lack of technical complexity. Indeed, Hermida et al. showed no difference in feasibility and reliability comparing septal and RAA pacing sites, whereas septal pacing was associated with shorter interatrial activation times and reduced left atrial electromechanical delay (36). 

Unlike ventricular lead placement, venous access has little effect on atrial lead positioning. Whether from the right or left venous access, the preformed J or straight electrode with preformed J stylet is easily maneuvered into the atrial appendage or desired position. It should be noted that a right lateral atrial position is more easily achieved by a right venous access. Atrial septal positions are more easily achieved from the left. 

Fig. 18.15 Posteroanteiior (i4) and lateral (B) chest radiographs of a dual-chamber pacing system. The atrial lead is positioned in a septal position (arrow). This patient had extremely long intra-atrial conduction times, and septal placement was the only way to maintain effective atrioventricular synchrony.

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