Septal pacing – X-ray chest PA view: Pulse generator is seen in the left infraclavicular region and the lead can be seen emanating from it. The lead is usually inserted through a left subclavian or axillary vein puncture using percutaneous technique. Under fluoroscopic guidance the lead tip is positioned in the right ventricle. Earlier most of the lead tips were positioned at the apex of the right ventricle. Though this position is easier to achieve, long term adverse of right ventricular apical pacing can occur due to dyssynchrony of left ventricular contraction. Apical pacing usually has a left bundle branch block pattern. If septal pacing can be done using screw in leads as in this case, it is possible that it can capture the conduction system more proximally so that the dyssynchrony may be lesser. This has the advantage of better long term left ventricular function.
In terms of left ventricular function and width of the QRS, pacing the septal aspect of right ventricular outflow tract is another good option .