# Permanent Cardiac Pacing of the Right Ventricular Outflow Tract Guided by Real-time Assessment of Electromechanical Synchrony

## TL;DR

A new method for implanting heart pacemakers in a specific area of the heart improves function and avoids complications.

## Contribution

A novel technique using real-time electromechanical synchrony assessment improves RVOT pacemaker implantation outcomes.

## Key findings

- 98% of patients achieved adequate pacing parameters with no complications.
- Pacing thresholds remained stable and no leads required repositioning during follow-up.
- Real-time CCA helps achieve cardiac synchrony in most cases during implantation.

## Abstract

Permanent right ventricular apical pacing deteriorates cardiac systolic function in some patients. We investigated an alternative site for permanent pacemaker (PPM) lead positioning with the goal of achieving more physiological pacing. A total of 132 patients with bradyarrhythmias underwent PPM implantation at the right ventricular outflow tract (RVOT) with conventional active-fixation leads. A real-time cross-correlation analysis (CCA) was performed using the Synchromax® software (EXO Health, Seattle, WA, USA) to determine the optimal site for ventricular lead implantation based on the cardiac synchrony index. The follow-up period ranged from 6–36 months, and the following parameters were assessed: pacing capture threshold, lead stability, and the need for lead repositioning. Adequate parameters were achieved in 129 patients (98%), and there were no procedure-related complications. At follow-up, no leads were dislodged, pacing thresholds remained stable, and no lead required repositioning. Using real-time CCA as an intraoperative parameter during PPM implantation at the septal RVOT helps to achieve cardiac synchrony in the vast majority of cases. This technique is a simple, effective, and safe way to simplify and standardize PPM implantation at the RVOT.