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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, OBJECTIVE, RESULTS. Meshes: Aged, Aged, 80 and over, Anatomic Landmarks, Cardiac Pacing, Artificial, Echocardiography, Electrodes, Implanted, Female, Fluoroscopy, Follow-Up Studies, Heart Septum, Humans, Male, Prosthesis Implantation.
user
Does comparison of tools and techniques for implanting pacemaker lead on the ventricular mid-septum? Context: Many physicians target the interventricular septum for pacemaker implantation, but the lead may inadvertently end up in an anterior position. We sought to compare two stylet shapes to achieve mid-septal lead placement, as well as the utility of a novel right anterior oblique (RAO) fluoroscopic landmark. Patients undergoing pacemaker implantation were enrolled into four consecutive groups according to stylet shape: a standard curve [two-dimensional (2D) stylet] or with an additional distal posterior curve [three-dimensional (3D) stylet], and whether RAO fluoroscopy was used. Left oblique anterior (LAO) and postero-anterior (PA) fluoroscopic views were used in all cases. After implantation, validation of right ventricular lead position (septal vs. anterior) was performed by echocardiography. A total of 113 patients were included, of whom lead position could be validated in 106 patients. Septal position was achieved in only 10 of 22 (45%) patients in the 2D stylet group and in 17 of 23 (74%) patients in the 3D stylet group (P = 0.07) when only PA and LAO fluoroscopy were used. Results were significantly improved by additional use of RAO fluoroscopy, with successful septal placement in 25 of 28 (89%) patients in the 2D stylet + RAO group (P = 0.001) and 32 of 33 (97%) patients in the 3D stylet + RAO group (P = 0.015).
assistant
A septal lead position was obtained in only about half of the patients when a 2D stylet was used with only LAO and PA fluoroscopic views. A 3D stylet was useful to attain the target position, and additional RAO fluoroscopy significantly improved success rate with both stylet shapes. Final Decision: yes