Effects of Right Ventricular Pacemaker Lead Position Assessed by MRI

Effects of Different Right Ventricular Lead Positioning on Cardiac Contraction Measured by Cardiac MRI: a Pilot Trial

Chronic right ventricular apical pacing has been associated with negative hemodynamic effects. Clinical outcome of right ventricular pacing can be influenced by multiple factors. An important factor seems to be optimal lead positioning. Data regarding left ventricular function impaired by lead positioning is insufficient. The aim of the present study therefore is to compare right ventricular apical pacing (RVAP) with right ventricular septal pacing (RVSP). Outcome measurements are echocardiographic features, magnetic resonance imaging and clinical outcome.

Inclusion criteria:

• patients with dysrhythmia requiring dual-chamber pacemaker implantation
• planed MRI-pacemaker implantation (Accent MRI System,St. Jude Medical)
• age between 18-90 years
• no absolute pacemaker dependence
• no present heart failure or any significant coronary heart disease (exclusion by anamnesis and echocardiography - LVH <15mm, LV EF>50%)
• no previous myocardial infarction or significant coronary artery disease
• life expectancy > 1 year
• patients willing to participate in follow-up

Exclusion criteria:

• Contraindications for MRI (Brain aneurysm clips, artificial heart valves, artificial joints, vascular stents)
• Any contraindication for surgery
• Absolute pacemaker dependence
• Claustrophobia
• GFR<30ml/min/1,73m2
• Allergy to contrast agent