Pacemaker lead locations

Yesterday I found out where my pacemaker leads are located. One is in the RV Apex and the other is the RA Appendage. It also said “ Right ventricle model, and AV block with 2:1 AV conduction.

 I have googled this but would still like any input that anyone can share about the above information.





Lead Placement

by AgentX86 - 2020-06-16 16:11:04

The lead placement seems pretty ordinary to me.  As far as the 2:1 conduction, well, the AV node drops every other heartbeat so your PM has to make up for it.  It's not uncommon but it's a real reason to have a PM.  Sounds like you're in good hands.

Did he say "Right Ventricle Remodeling",  If so, it means that your right ventricle isn't normal and has probably enlarged or thickened.  This isn't usually critical but it's probably something they're going to want to watch.  It's a good question for your cardiologist though.

Lead placement

by Sisterwash65 - 2020-06-16 22:20:18

Thanks so your explanation of the 2:1 conduction. I couldn’t find an answer to that anywhere. He did tell me that my heart was working right about 50% of the time ! Since you seem so knowledgeable, I’d like to ask you a few other things I haven’t been able to find.

1)”MidCx has 50% stenosis. Lesion is eccentric and heavily calcified. Culprit lesion FFR Lesion on 2nd Ob Marg...”

2.)This information is all coming from the summary the doctor wrote that I saw in my patient portal. Follow up visit is June 30th. And no, the report doesn’t mention “ right ventricle “ remodeling. I do have some enlargement though. 

3.) Several times in the report it says this,” Pre-procedure TIMI lll flow was noted, good runoff was present.” I thought the TIMI lll was used to rate heart attacks. What does it mean used in this context ? And what is a culprit lesion if you haven’t had a heart attack ?

Thank you for taking time out to explain and help me sort through all this !

Questions. Answers?

by AgentX86 - 2020-06-16 22:57:30

I'm not great with the anatomy of the heart and associated problems.  I have had a triple CABG (the fourth wasn't worth the heart-lung machine time after the Maze and LAA clip took up the time).  I never got all that interested in the plumbing for some reason.  I'm a EE so pacemakers interest me more and there is more reason to understand them because you can effect the outcome.

That said,the CX is the artery the supplies much of the right ventricle. I think the "Mid Cx" is the middle part between two arteries that branch off the CX.  It sounds to me like you have a 50% blockage (stenosis) of this artery in this mid-secton and the blockage is to one side of the artery and made of calcium rather than fat.  The blockage isn't good but if you have to have one, calcium is preferred.  Fat (cholesterol) deposits can break off easily and cause a heart attack.  Calcium deposits are less likely to travel.  Again, it's a guess but 50% isn't so good but not an emergency.  Mine were all over 80% with a couple at 100% blocked.

FFL is the Fractional Flow something or other.  It's a measure of the flow through the occluded artery, caused by the blockage (the culprit in the stenosis).  I think the blockage is referred to as the "lession" here.  It's not a heart attack, yet.  "Good runoff" I can only guess at.  Perhaps it means that the FFL is good and nothing is needed immediately but that's only a guess. These are things to ask your cardiologist.  He should be able and willing to explain this.  The more you can study on your own, the easier it's going to be to communicate.


Chamber enlargement is remodeling.  Something has increased the size of the RV or "remodeled" it.

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Try to concentrate on how you’re able to be active again and feel normal, rather than on having a machine stuck in your body.