Low atrial septal pacing with a handmade stylet when right atrial appendage pacing is difficult: A case series
Dual chamber pacemakers are implanted for symptomatic sick sinus syndrome and atrioventricular block. In many cases, atrial leads are implanted in the right atrial appendage (RAA) during dual chamber pacemaker implantation because of the simplicity of the procedure. However, there may be no lead placement site with good wave amplitude and threshold due to fibrosis and remodeling of the RAA. In such cases, the options are high atrial septal pacing with pacing near the Bachmann bundle or low atrial septal (LAS) pacing with pacing near Koch’s triangle, but fewer delivery catheters are suitable for the atrial septum than the ventricular septum.