We have located links that may give you full text access.
Anatomic, Histologic and Mechanical Features of the Right Atrium: Implications for Leadless Atrial Pacemaker Implantation.
BACKGROUND: Leadless pacemakers (LP) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LP 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 MRI, and computer simulation), to identify the optimal safest location to implant an atrial LP human.
METHODS: Wall thickness and anatomic relationships of the RA was 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.
RESULTS: 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/SVC junction and septum appear to be sub-optimal fixation locations.
OBJECTIVES: We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models (gross anatomy, cardiac MRI, and computer simulation), to identify the optimal safest location to implant an atrial LP human.
METHODS: Wall thickness and anatomic relationships of the RA was 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.
RESULTS: 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/SVC junction and septum appear to be sub-optimal fixation locations.
Full text links
Related Resources
Trending Papers
Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows.Endocrine Reviews 2024 April 28
The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association.Circulation 2024 April 26
Intravenous infusion of dexmedetomidine during the surgery to prevent postoperative delirium and postoperative cognitive dysfunction undergoing non-cardiac surgery: a meta-analysis of randomized controlled trials.European Journal of Medical Research 2024 April 19
Interstitial Lung Disease: A Review.JAMA 2024 April 23
Ventilator Waveforms May Give Clues to Expiratory Muscle Activity.American Journal of Respiratory and Critical Care Medicine 2024 April 25
Acute Kidney Injury and Electrolyte Imbalances Caused by Dapagliflozin Short-Term Use.Pharmaceuticals 2024 March 27
Systemic lupus erythematosus.Lancet 2024 April 18
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app