Mechanical Vulnerability of Ventricular Septal Pacing

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Background: As stated in the ESC guidelines for cardiac pacing, ventricular septal pacing (VSP) has the advantage of preserving the LV function over right ventricular apical pacing after a permanent pacemaker implantation. Previously we reported that ICD/CRT-D shock leads are not suitable for VSP, because of the possibility of a micro-dislodgement by the lead’s own weight. As proof of this, ventricular pacing by using a pacemaker lead caused no such trouble during the observation period. Case Report: An 80-year-old man was referred for a DDD pacemaker implantation because of advanced atrioventricular block. VSP was administered by a screw-in lead. A stable ventricular voltage of more than 11.2 mV, and pacing threshold of 0.5 V/0.4 ms were kept for a year. According to the automatic measurements, a sudden decrease in the ventricular voltage and unstable pacing threshold occurred one year after the implantation. An X-ray of the chest showed the ventircular lead dislodgement, and therefore a lead exchange was performed. A histopathological analysis of the adherent tissue on the lead-tip revealed a fibrotic structure. Discussion: The device telemetry demonstrated normal values before the lead dislodgement. VSP by using a pacemaker lead has the same risk of lead dislodgement, as shown in our previous analysis using a shock lead. Conclusion: VSP has a mechanical vulnerability of being dislodged not only during the acute phase of the implantation, but also over in the long term.

Mechanical Vulnerability of Ventricular Septal Pacing

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