Insertion of an active fixation lead in the inferior interatrial septum via a 9.0 Fr guiding catheter

Placing an atrial lead in the inferior interatrial septum (IAS) reportedly reduces the incidence of paroxysmal atrial fibrillation (AF) and slows the progression to chronic AF; however, in certain cases, inferior IAS pacing is technically difficult. When this procedure is unsuccessful, insertion of the lead in the right atrial appendage can be considered, but it is associated with a risk of cardiac perforation. Here, we describe a technique for lead insertion in the inferior IAS via a 9.0 Fr guiding catheter, which may serve as an alternative technique for inferior IAS pacing when the conventional stylet-guided insertion is not successful.