Association between computed tomography-verified pacing location of
Micra™ leadless pacemakers and characteristics of paced
electrocardiograms in bradycardia patients
Abstract
Introduction: The leadless pacemakers are implanted routinely
under fluoroscopic image, yet the pacing sites and corresponding paced
electrocardiography (ECG) remain unclear. This study was to determine
the computed tomography (CT)-verified location of the leadless Micra™
pacemakers (Micra™) and ECG characteristics. Methods: 20
consecutive patients who met the pacemaker indications for bradycardia
and underwent fluoroscopy assisted Micra TM
implantation were enrolled. All subjects underwent a postoperative CT
scan to determine the precise location of the Micra TM
pacing tip. Paced 12-lead ECG characteristics were analysed and
correlated with the Micra TM tip location.
Results: In the nine partitions of fluoroscopic RAO images, 14
(70%) of 20 patients had the Micra TM tip in zone 5,
5 (25%) in zone 6 and 1 in zone 2. Reconstructed CT 3-D cardiac images
found Micra TM tips mostly clustered near the anterior
insertion between the RV septum and free wall with 12 cases at the
insertion-septal side and 8 at the free-wall side. ECG morphological
analysis found that the peak deviation index in ECG lead V1 was
0.402±0.061 for Micra TM tips at the insertion-septal
side and 0.542±0.053 in the free-wall side (P <0.001 between two
sides) and paced clumsy R wave was often observed for tips at the
free-wall side though there was no difference in QRS duration between
two sides. Conclusion. In routine Micra TM
implantation, the pacing sites were often located in the anterior
insertion region, either at the insertion-septal or free-wall side. The
ventricular activation propagation likely depended on the pacing sites.