ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Regionalization of the atria for 3D electroanatomical mapping, cardiac imaging, and computational modelling: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Cardiovascular Imaging of the ESC.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Guideline
- Leadless Atrial Pacemaker Implantation at a Nonstandard Site After Unsuccessful Conventional Atrial Placement.Journal of arrhythmia · 2026Article
- Perisinus nodal atrial pacing at the right anterosuperior site using a leadless atrial pacemaker: A case series.HeartRhythm case reports · 2026Article
- Anteroseptal implantation of a leadless atrial pacemaker: Relevant anatomy for alternate sites into the Bachmann area.HeartRhythm case reports · 2026Article
- Novel technique for leadless pacemaker implantation in the small right atrial appendage: a case report.European heart journal. Case reports · 2026Article
- Leadless pacemaker implantation in the region of Bachmann's bundle: initial results.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Era of Synchronized Physiologic Leadless Pacing: A Novel Approach to Cardiac Pacing and Ongoing Development.Journal of clinical medicine · 2026Review
- Is regional atrial strain a useful surrogate of regional atrial fibrosis in atrial cardiomyopathy?European heart journal. Imaging methods and practice · 2025Article
- A Self-Expanding Nitinol Fixation System for Atrial Leadless Pacemakers: Biomechanical Design and Evaluation.Bioengineering (Basel, Switzerland) · 2025Article
- Helix-fixed leadless pacemaker implantation requiring the gooseneck snaring technique for passage through the tricuspid valve: A case series.HeartRhythm case reports · 2025Article
- Physiological Pacing: Historical Review With an Eye to the Future.Journal of cardiovascular electrophysiology · 2025Review
- Right haemothorax secondary to pulmonary vein laceration following left-sided pacemaker implantation: a case report.European heart journal. Case reports · 2025Article
- Impact of the dispersive patch placement on dissipated power in radiofrequency ablation for pulmonary vein isolation via a virtual patient study.Scientific reports · 2025Article
- Sex differences in atrial potential morphology.International journal of cardiology. Heart & vasculature · 2025Article
- Dual-chamber leadless pacemaker in complex adult congenital heart disease: a case report.European heart journal. Case reports · 2024Article
- Successful atrial lead implantation using a guiding catheter-based system in challenging anatomical and electrophysiological cases: A case series.HeartRhythm case reports · 2024Article
- Successful radiofrequency catheter ablation of focal atrial tachycardia originating from right atrial appendage anomaly.HeartRhythm case reports · 2024Article
- Cardiac devices in the adult congenital population; A blessing and a curse.International journal of cardiology. Congenital heart disease · 2024Article
- Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up.Journal of clinical medicine · 2024Article
- How sex affects the sinus rhythm heartbeat.International journal of cardiology. Heart & vasculature · 2023Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundLeadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known.
objectivesWe aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models [gross anatomy, cardiac magnetic resonance imaging (MRI), and computer simulation], to identify the optimal safest location to implant an atrial LP human. METHODS AND
resultsWall thickness and anatomic relationships of the RA were studied in 45 formalin-preserved human hearts. In vivo RA anatomy was assessed in 100 cardiac MRI scans. Finally, 3D collision modelling was undertaken assessing for mechanical device interaction. Three potential locations for an atrial LP were identified; the right atrial appendage (RAA) base, apex, and RA lateral wall. The RAA base had a wall thickness of 2.7 ± 1.6 mm, with a low incidence of collision in virtual implants. The anteromedial recess of the RAA apex had a wall thickness of only 1.3 ± 0.4 mm and minimal interaction in the collision modelling. The RA lateral wall thickness was 2.6 ± 0.9 mm but is in close proximity to the phrenic nerve and sinoatrial artery.
conclusionsBased on anatomical review and 3D modelling, the best compromise for an atrial LP implantation may be the RAA base (low incidence of collision, relatively thick myocardial tissue, and without proximity to relevant epicardial structures); the anteromedial recess of the RAA apex and lateral wall are alternate sites. The mid-RAA, RA/superior vena cava junction, and septum appear to be sub-optimal fixation locations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.