LP implantation
All the LP implantations were performed by experienced
electrophysiologists under conscious sedation and pain control with
opioid agents. The device was delivered into the right ventricle by a
deflectable catheter through a percutaneous femoral approach. In cases
without temporary pacemaker using an active-fixation pacing lead,
temporary pacemaker was inserted into the right ventricular apex from
the femoral vein aiming for a backup pacing and as an anatomical
landmark. Once the catheter was positioned in the right ventricle, a
suitable site of attachment in a septal position was identified
according to the standard anatomical landmarks, and the location was
then confirmed by injecting contrast medium into the right ventricle and
filming in two complementary radiological projections. In case of the
previous use of an active-fixation lead for temporary pacing after the
TLE, we looked for an anchoring site for the LP that was not too close
to the transvenous lead tip. The device fixation was considered adequate
when the movement of at least 2 of 4 tines was confirmed. Following the
device placement in the right ventricle, electrical measurements such as
the pacing thresholds, pacing impedance, and R-wave amplitude were
checked. If an adequate deployment was confirmed, the device was
released from the tether, otherwise repositioning to another site of the
right ventricle was attempted. A figure of eight stitch was used to
guarantee correct hemostasis at the femoral cannulation site and was
removed on the next day. The device data including pacing capture
threshold, pacing impedance and R-wave amplitude were collected
prospectively and electrocardiography and chest radiography were
undergone for excluding the procedural adverse events before hospital
discharge.
Patients were followed in the setting of regular care visits at our
centers at 1 month and 6 months after LP implantation. Besides, they
underwent clinical follow-up including laboratory tests for signs of
ongoing infection at the satellite local doctors.