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Master Thesis

L'incidence oblique antérieure gauche individualisée pour le positionnement de la sonde ventriculaire droite : cohorte comparative avec la méthode fluoroscopique classique

Abstract : Background : Individualized left anterior oblique projection (I-LAO) has demonstrated better identification of right ventricular (RV) lead positioning than classical fluoroscopy criteria. We evaluated if the use of I-LAO at the time of RV lead placement enabled more constant septal positioning than using classical fluoroscopy criteria.
Aim : To assess true septal RV lead implantation success using individualized OAG in a prospective cohort of patients undergoing pacemaker or defibrillator implantation.
Methods : I-LAO was defined by the degree of LAO that allowed the perfect superposition of the RV apex (using the tip of the RV lead temporarily placed at the apex) and of the SVC-IVC axis (materialized by a guidewire), to which we added a caudal angle of 10-15° to best approximate a true profile view of the septum. In the study group, the ventricular septum was targeted using I-LAO in patients undergoing pacemaker/defibrillator implantation, using the rightwards orientation of the RV lead tip. We used a control group of patients demonstrating rightwards orientation of the RV lead tip in LAO 40° at end-procedural fluoroscopy, suggesting septal positioning. True RV lead placement was then assessed using TTE and compared between both groups.
Results : We included 58 patients in the study group and 85 in the control group. True RV lead positioning in TEE was septal in all 58 (100%) patients of the study group vs. 63/85 (74.1%) patients of the control group (p<0.001). Procedural data and complications were comparable in both groups, but pericardial effusion/tamponnade occurred only in the control group (2/85; 2.4%), in patients with RV free wall leads.
Conclusion : Individualized LAO allows constant septal RV lead positioning and should therefore replace generic fluoroscopy criteria.
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Master Thesis
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Submitted on : Tuesday, November 26, 2019 - 1:56:33 PM
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Alexandre Poulard. L'incidence oblique antérieure gauche individualisée pour le positionnement de la sonde ventriculaire droite : cohorte comparative avec la méthode fluoroscopique classique. Médecine humaine et pathologie. 2019. ⟨dumas-02380837⟩

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