Table 3.
Summary of potential RA LPM implant locations
| Location | Wall thickness | Device contact (per cardiac cycle) (%) | Potential perforation risk | Potential dislodgement risk | Other potential risks | Potential advantages |
|---|---|---|---|---|---|---|
| RAA base | 4.2 ± 1.4mm | <20 | Low | Low | Easy implant (and retrieval) approach | |
| RAA apex (anteromedial recess) | 1.0 ± 0.5mm | <20 | Low–moderate | Low–moderate | Poor device orientation for inter-device communication | Will accommodate whole device within RAA (low dislodgement risk) |
| RA lateral wall | 2.6 ± 0.9 mm | <20 | Low | Moderate | Risk of PNS | |
| RAA body | Paper thin between trabeculations | >80 | High | Moderate | Risk of RAA perforation with rear of device | |
| Superior CT | 4.2 ± 1.4 mm | >80 | Low | Moderate | Variable location | Easy implant (and retrieval) approach |
| Absent in 12% | ||||||
| Difficult to target (small region) | ||||||
| High risk of PNS | ||||||
| Atrial septum | Not studied | <20 | Low | High | Inadvertent LA placement (PFO/ASD) |
ASD, atrial septal defect; CT, crista terminalis; LPM, leadless pacemaker; PFO, patent foramen ovale; PNS, phrenic nerve stimulation; RA, right atrium; RAA, right atrial appendage.