Usefulness of a long-straight sheath for atrial lead insertion at the right atrial septum

Background: Pacing at the right atrial septum (RAS) appears to be superior to that performed at the right atrial appendage for preventing paroxysmal atrial fibrillation and for reducing complications. However, atrial lead inser-tion at the RAS is difficult and time-consuming. Although a few useful devices have been reported, handling of the atrial lead around the RAS is sometimes difficult even with those devices. Therefore, in the present study a long-straight sheath (LSS) was used in an attempt to secure sufficient space for handling the atrial lead around the RAS. Methods and Results: Seventy-six consecutive patients who underwent insertion of an atrial lead at the RAS from a left-sided approach were examined. The non-LSS group comprised 24 patients and the LSS group had 52. The success rate of atrial lead insertion was significantly higher in the LSS group than in the non-LSS group [50/52 (96.1%) vs 13/24 (54.2%); p<0.01]. The operation time was significantly shorter in the LSS group (13.6±9.1 min vs 32.7±11.1 min, p<0.01). P wave duration was significantly shorter during RAS pacing than during normal sinus rhythm. Conclusion: The LSS technique is useful for atrial lead insertion at the RAS because it enables sufficient space to be secured for lead handling.