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• W123201118 abstract "Background and ObjectivesThe gross anatomy of the right atrial appendage (RAA) and its relationships with the crista terminalis (CT) and the taenia sagittalis (TS) has been poorly described. The RAA is the most common region where leads for the permanent atrial pacing are placed. The atrial leads technology available for lead placement and anchorage is mainly represented by the active or passive fixation. The reliability of active-fixation atrial leads has been compared with passive-fixation ones; straight and J-shaped screw-in lead systems have also been compared. Few data are available on procedural and short-term safety. The first part of this thesis is a comprehensive review about the modern cardiac pacing, mainly oriented to the atrial permanent pacing clinical aspects, technique and materials. The second part is an original contribution about a brief anatomy overview of right atrial structures involved in the permanent pacing including also a retrospective procedural safety comparison among three different atrial pacing leads technologies. Patients and Methods An anatomical study of a consecutive series of human hearts specimens coming from routine autopsies, performed at the Cardiovascular Pathology Unit of the Department of Cardiac, Thoracic and Vascular Sciences of University of Padua, is reported. A total of 100 human hearts have been examined to analyze the macroscopic anatomy of CT and TS. Attention was paid to the anatomic variability of TS in its entrance into the RAA. Data were compared with the recent literature.A retrospective study was then carried out, with the aim to analyze the clinical impact on procedural safety of the main currently available atrial leads technologies for permanent pacing. To this purpose, from January 2004 to January 2010, 1464 patients who underwent to a new pacemaker/implantable cardioverter defibrillator (ICD) implantation, were recruited. Among these, 915 (study population) received a passive or active fixation pre-J-shaped or a straight screw-in atrial lead; the remaining 549 patients, who received only a ventricular lead (VVI pacemakers), were excluded. The 3 study groups were: Group S-FIX (165 patients, 18%) receiving a straight screw-in atrial lead (post-shaped in right appendage); Group J-PASS (690 patients, 75.4%) receiving a passive-fixation J-shaped atrial lead and Group J-FIX (60 patients, 6.6%), receiving an active fixation screw-in J-shaped atrial lead.Procedural and short-term complication rates have been analyzed up to 3 months post-implantation. ResultsAnatomic review: TS has shown 3 main kinds of anatomic variability related to the presence of a main trunk TS (type 1 present in 76% of cases), a double TS (type 2 present in 13% of cases) and a fine arborization without a clear TS represented (type 3 present in 10% of cases). A triple morphology of TS was found in one case. The RAA region proximally to TS (or antral RAA region) is facing the aortic root, without a clear pericardial space in between; the distal region of the RAA, behind TS (or RAA region) is not facing closely the pulmonary artery infundibulum, due to its unbound nature that better comply the atrial systolic cycles. This could represent a safer region for leads placement, especially for screw-in technology.Procedural atrial leads technology comparison: One complication occurred in each group as follows: one case of sterile pericarditis in the S-FIX group (0.6%) vs one case of sustained atrial fibrillation in the J-PASS group (0.1 %) vs one case of pleuro-pericardial atrial lead perforation/migration in the J-FIX group (1.7 %). The p values were 0.3, 0.1 and 0.4 respectively for each rates comparison. The rate of atrial lead dislodgement was higher in the group J-PASS compared with the group S-FIX but not with the group J-FIX, and is distributed as follows: group S-FIX 0 cases vs group J-PASS 16 (2.3%) cases vs group J-FIX 1 (1.7%) case (p=0.04 and 0.7 respectively).ConclusionsThe saccular RAA could be a safer region for atrial leads insertion and anchorage compared with the “antral” RAA, which is quite close to the ascending aorta. However, in our case series the procedural complications of all the 3 available leads technologies were very low. In particular, no aortic perforations occurred.Straight screw-in atrial leads, “J post-shaped” in the RAA, offer a better stability compared with the passive J pre-shaped fixation and displayed a similar acceptable safety profile compared with both the J pre-shaped systems." @default.
• W123201118 created "2016-06-24" @default.
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• W123201118 date "2013-02-03" @default.
• W123201118 modified "2023-09-27" @default.
• W123201118 title "Permanent atrial pacing: anatomical study of the right atrium pacing atrial lead technologies procedural safety" @default.
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