Location, location, location….

There has been a great evolution in pacemaker lead and technology from the initial pacemakers and leads that were originally available. With the first leads, any place in the heart that would allow good sensing and stimulation thresholds defined optimal lead placement. However, with advances in technology, the ability to pace a specific area or region has become available. With the case of para-Hisian as well as left bundle pacing, very specific locations in the heart can be chosen to achieve optimal synchrony. However, even with standard pacing leads, the approach of just place the lead anywhere in the right ventricular apex and move on should strongly be reconsidered. Now with the ability to pace the heart endocardially or epicardially and pace either the left ventricle or the right ventricle, there are even more options to create or alleviate problems in the pacing population. However, as we move forward with new technologies, we must be aware of the new challenges they present. Castellanos et al describe a very thorough study of pacing leads and dyssynchrony caused by these leads as well as pathologic evidence of myocardial damage. 1 Daniel A. Castellanos, Chrystalle Katte Carreon, Ashwin Prakash, et al. Pacemaker lead insertion sites contribute to abnormalities of myocardial function and histopathology. Heart Rhythm: in press 2023. Google Scholar Pacemaker lead insertion sites contribute to abnormalities of myocardial function and histopathologyHeart RhythmPreviewVentricular pacing can cause myocardial dysfunction, but how lead anchoring to the myocardium affects function has not been studied. Full-Text PDF