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Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation
BACKGROUND: Leadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known. OBJECTIVES: We aimed to evaluate the right atrial (...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473833/ https://www.ncbi.nlm.nih.gov/pubmed/37523771 http://dx.doi.org/10.1093/europace/euad235 |
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author | O’Connor, Matthew Barbero, Umberto Kramer, Daniel B Lee, Angela Hua, Alina Ismail, Tevfik McCarthy, Karen P Niederer, Steven Rinaldi, Christopher A Markides, Vias Clarke, John-Ross D Babu-Narayan, Sonya Ho, Siew Yen Wong, Tom |
author_facet | O’Connor, Matthew Barbero, Umberto Kramer, Daniel B Lee, Angela Hua, Alina Ismail, Tevfik McCarthy, Karen P Niederer, Steven Rinaldi, Christopher A Markides, Vias Clarke, John-Ross D Babu-Narayan, Sonya Ho, Siew Yen Wong, Tom |
author_sort | O’Connor, Matthew |
collection | PubMed |
description | BACKGROUND: Leadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known. OBJECTIVES: We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models [gross anatomy, cardiac magnetic resonance imaging (MRI), and computer simulation], to identify the optimal safest location to implant an atrial LP human. METHODS AND RESULTS: Wall thickness and anatomic relationships of the RA were studied in 45 formalin-preserved human hearts. In vivo RA anatomy was assessed in 100 cardiac MRI scans. Finally, 3D collision modelling was undertaken assessing for mechanical device interaction. Three potential locations for an atrial LP were identified; the right atrial appendage (RAA) base, apex, and RA lateral wall. The RAA base had a wall thickness of 2.7 ± 1.6 mm, with a low incidence of collision in virtual implants. The anteromedial recess of the RAA apex had a wall thickness of only 1.3 ± 0.4 mm and minimal interaction in the collision modelling. The RA lateral wall thickness was 2.6 ± 0.9 mm but is in close proximity to the phrenic nerve and sinoatrial artery. CONCLUSIONS: Based on anatomical review and 3D modelling, the best compromise for an atrial LP implantation may be the RAA base (low incidence of collision, relatively thick myocardial tissue, and without proximity to relevant epicardial structures); the anteromedial recess of the RAA apex and lateral wall are alternate sites. The mid-RAA, RA/superior vena cava junction, and septum appear to be sub-optimal fixation locations. |
format | Online Article Text |
id | pubmed-10473833 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-104738332023-09-02 Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation O’Connor, Matthew Barbero, Umberto Kramer, Daniel B Lee, Angela Hua, Alina Ismail, Tevfik McCarthy, Karen P Niederer, Steven Rinaldi, Christopher A Markides, Vias Clarke, John-Ross D Babu-Narayan, Sonya Ho, Siew Yen Wong, Tom Europace Clinical Research BACKGROUND: Leadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known. OBJECTIVES: We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models [gross anatomy, cardiac magnetic resonance imaging (MRI), and computer simulation], to identify the optimal safest location to implant an atrial LP human. METHODS AND RESULTS: Wall thickness and anatomic relationships of the RA were studied in 45 formalin-preserved human hearts. In vivo RA anatomy was assessed in 100 cardiac MRI scans. Finally, 3D collision modelling was undertaken assessing for mechanical device interaction. Three potential locations for an atrial LP were identified; the right atrial appendage (RAA) base, apex, and RA lateral wall. The RAA base had a wall thickness of 2.7 ± 1.6 mm, with a low incidence of collision in virtual implants. The anteromedial recess of the RAA apex had a wall thickness of only 1.3 ± 0.4 mm and minimal interaction in the collision modelling. The RA lateral wall thickness was 2.6 ± 0.9 mm but is in close proximity to the phrenic nerve and sinoatrial artery. CONCLUSIONS: Based on anatomical review and 3D modelling, the best compromise for an atrial LP implantation may be the RAA base (low incidence of collision, relatively thick myocardial tissue, and without proximity to relevant epicardial structures); the anteromedial recess of the RAA apex and lateral wall are alternate sites. The mid-RAA, RA/superior vena cava junction, and septum appear to be sub-optimal fixation locations. Oxford University Press 2023-07-31 /pmc/articles/PMC10473833/ /pubmed/37523771 http://dx.doi.org/10.1093/europace/euad235 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Research O’Connor, Matthew Barbero, Umberto Kramer, Daniel B Lee, Angela Hua, Alina Ismail, Tevfik McCarthy, Karen P Niederer, Steven Rinaldi, Christopher A Markides, Vias Clarke, John-Ross D Babu-Narayan, Sonya Ho, Siew Yen Wong, Tom Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title | Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title_full | Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title_fullStr | Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title_full_unstemmed | Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title_short | Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
title_sort | anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473833/ https://www.ncbi.nlm.nih.gov/pubmed/37523771 http://dx.doi.org/10.1093/europace/euad235 |
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