Feasibility of Echocardiography-guided Percutaneous Transapical Lead Implantation for Intraventricular Septal Pacing: Acute and 3-Month Evaluation

Sep 30, 2026

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Transvenous lead implantation can be hindered by venous access limitations and lead-related complications. This study assessed the feasibility and safety of an echocardiography-guided percutaneous transapical intraventricular septum pacing approach (PTAIVS) in an animal model using 12 adult dogs. Transthoracic and transoesophageal echocardiography guided percutaneous apex access and septal fixation. All animals achieved successful placement without procedural complications, with acute capture and sensing parameters reported. Initial unmodified systems caused 1-month lead dislodgement; system modifications prevented dislodgement at 1 month but displacement persisted by 3 months, supporting further refinement for long-term stability.

LanguageEnglish

CategoryHealthcare

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Reading Time15 min

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Abstract

Background

Methods

Results

Conclusion

Clinical ORIGINAL RESEARCH Electrophysiology and Ablation Feasibility of Echocardiography-guided Percutaneous Transapical Lead Implantation for Intraventricular Septal Pacing: Acute and 3-Month Evaluation Zhaohui Qiu ,1 Xianhao Wu ,1 Haiyan Chen,2 Ke Du ,1 Jing Ni,1 Zheng Li ,3 Yuhua Tang ,1 Wei Hu,1 Zhongcheng Xu 1 and Mingyue Sun1 1. Department of Cardiology, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2. Department of Cardiac Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China; 3. Laboratory Animal Division, Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China Abstract Background: Transvenous lead implantation often faces challenges regarding venous access and lead-related complications. This study evaluated the feasibility and safety of a novel echocardiography-guided percutaneous transapical intraventricular septum (PTAIVS) pacing approach in an animal model. Methods: Twelve adult dogs underwent PTAIVS lead implantation guided by transthoracic and transoesophageal echocardiography. Leads were introduced percutaneously through the apex and fixed in the mid-to-basal septum. The first six dogs were implanted with a pacing set with a coaxial introducer needle (CareFusion) and a Model 3830 lead (Medtronic), whereas an improved pacing set with an extended helix lead was used in the next six dogs. The first three dogs were used for evaluation of acute gross pathology, with the remaining nine followed up over a period of 4–12 weeks. Pathological examinations were performed at the end of the follow-up period. Results: Successful lead placement without procedural complications was achieved in all dogs, with a mean (± SD) procedural time of 28.8 ± 4.8 min. At implantation, the median (interquartile range) capture threshold was 1.7 (0.85–2. 50) V, the R-wave amplitude was 6.80 (6 .13–13. 00) mV and impedance was 536 (510–922) Ω . In the initial six dogs in which the unmodified pacing system was used, lead dislodgement occurred atthe 1-month follow-up. Modifications to the system eliminated dislodgement at 1 month, but varying degrees of displacement were observed by 3 months. Conclusion: This study demonstrates the initial technical feasibility of echocardiography-guided PTAIVS pacing, offering a potential alternative to traditional transvenous methods. However, further refinements are essential to improve long-term lead stability. Keywords Echocardiography-guided, intraventricular septal pacing, percutaneous pacing, transapical, transvenous lead Received: 13 March 2025 Accepted: 12 July 2025 Citation: Arrhythmia & Electrophysiology Review 2025;14:e32 . DOI: [https://doi.org/10.15420/aer.2025.14](https://doi.org/10.15420/aer.2025.14) Disclosure: The authors have no conflicts of interest to declare. Funding: This work was supported by a grant from the Interdisciplinary Program of Shanghai Jiao Tong University (No. YG2024LC14) . Acknowledgements: The authors thank Yun Cai (Department of Cardiology, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China) and Hongyang Lu (Cardiac Rhythm Management, Medtronic Technology Center, Medtronic Shanghai Ltd, Shanghai, China) for proofreading the manuscript. ZQ, XWand HC contributed equally. Data availability: The data that support the findings of this study are available in the article and the supplementary material. Authors’ contributions: Conceptualisation: ZQ; data curation: KD, JN, WH, ZX, MS; formal analysis: KD, JN, WH, ZX, MS; funding acquisition: ZQ; investigation: ZQ, XW, HC, ZL, YT; project administration: XW, KD; resources: ZQ, XW, HC; writing – original draft preparation: XW, HC; writing – review & editing: ZQ. Ethics: This study was approved by Institutional Ethics Committee of Animal Experimental Center in Shanghai Tong Ren Hospital and was performed and reported according to the ARRIVE guidelines for animal

FAQs

What clinical problem does the study address?

Transvenous lead implantation can be limited by challenges in venous access and by complications related to the leads.

How was the PTAIVS pacing approach performed in the animal model?

Twelve adult dogs underwent PTAIVS lead implantation guided by transthoracic and transoesophageal echocardiography, with leads introduced percutaneously through the apex and fixed in the mid-to-basal septum.

What were the key findings about lead stability over time?

All dogs achieved successful lead placement without procedural complications. In the first six dogs using the unmodified system, lead dislodgement occurred at 1 month; modifications eliminated dislodgement at 1 month, though displacement was observed by 3 months.

Sep 30, 2026

Uploaded by Mimi