Right ventricle/interventricular septum electrophysiological anatomy (determination of optimal right ventricular lead placement)

Notwithstanding a theoretically justified lead placement into the interventricular septum (IVS), the data from the clinical trials demonstrate somewhat controversial results. One of these controversies is the absence of consolidated criteria for positioning the electrode to deliver pacing from the interventricular septum (IVS) area. The study describes anatomic features of RV and IVS with respect to the cardiac conduction system, normal ventricular excitation and electrode implantation techniques for continuous pacing. A comparative study of 73 specimens of cadaver hearts was carried out by using electro-anatomic 3D mapping of the heart, X-ray examination, computer-aided tomography, morphological and morphometric investigation. It was found out that the medium part of IVS in the septomarginal trabecula zone could be considered the best for continuous pacing. The criteria for the RV lead to be implanted in this zone were determined.