Correlation of pacing site in right ventricle with paced QRS complex duration

Gupta, Anunay; Parakh, Neeraj; Bansal, Raghav; Verma, Shipra; Roy, Ambuj; Sharma, Gautam; Yadav, Rakesh Kumar; Naik, Nitish; Juenja, Rajnish; Bahl, Vinay K.

doi:10.1016/j.ipej.2018.08.001

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…After accounting for this error, the morphology of the wide QRS complex in both EKG's is the same. These findings suggest that the RV apex is the earliest site of depolarization with the left bundle being activated transeptally from the apex to the base as seen in a right ventricle pacing lead located in the apex [2]. Another less likely explanation would include two independent tachycardias.…”

Section: Discussionmentioning

confidence: 93%

Wide complex tachycardia in a COVID-19 patient: What is the mechanism?

Reddy¹,

Reddy²,

Mangat³

et al. 2020

Journal of Electrocardiology

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Section: Discussionmentioning

confidence: 93%

Wide complex tachycardia in a COVID-19 patient: What is the mechanism?

Reddy¹,

Reddy²,

Mangat³

et al. 2020

Journal of Electrocardiology

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“…This is in agreement with studies investigating RV pacing both in patients with normal cardiac function and in patients with heart failure. This emphasizes the need for replacement of the RV as standard lead implantation site, since especially pacing the RV will prolong QRS duration [ 12 ] and patients with RV paced QRS duration ≥150 milliseconds are of increased risk of developing pacing-induced cardiomyopathy [ 13 , 14 ]. RV pacing can eventually lead to adverse cardiac remodeling increasing the risk of atrial fibrillation (AF), heart failure, and cardiovascular death [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Heckman

Luermans

Čurila

et al. 2021

JCM

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Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

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“…Finally, as published by Gupta and cols, as well as other studies, the stimulated QRS duration difference between the groups, could be related to the different location predominant in each type of PM, considering that RV mid-septal and RVOT septal pacing were associated with significantly lower QRS duration as compared with apical pacing [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 67%

Conventional single-chamber pacemakers versus transcatheter pacing systems in a “real world” cohort of patients: A comparative prospective single-center study

Martínez‐Sande

García‐Seara

González‐Melchor

et al. 2021

Indian Pacing and Electrophysiology Journal

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Purpose Despite the developments in conventional transvenous pacemakers (VVI-PM), the procedure is still associated with significant complications. Although there are no prospective clinical trials that compared VVI-PM with transcatheter pacemaker systems (TPS). Methods This is a prospective, observational, single-center study that included all patients with an indication for a single-chamber pacemaker implant within a 4-year period. All clinical, ECG and echocardiographic characteristics at implant, electrical parameters, associated complications and mortality were analyzed. A Cox survival model and a Bayesian cohort analysis were performed for differences in complication rates between groups. Results There were 443 patients included (198 TPS and 245 VVI-PM). The mean age was 81.5 years (TPS group, 79.2 ± 6.6 years; VVI-PM group, 83.5 ± 8.9 years). There was a male predominance in TPS group (123, 62.1% vs. 67, 27.3%; p < 0.001). The presence of systolic dysfunction and renal insufficiency were more frequent in VVI-PM group than in TPS patients. Mean follow-up was 22.3 ± 15.9 months. In a multivariable paired data the TPS group presented fewer complications than VVI-PM group (HR = 0.39 [0.15–0.98], p-value 0.013), but major complications were not different (6, 3% vs 14, 5.6% respectively, p = 0.1761). There was no difference in the mortality rate between the groups. The TPS group had less risk than VVI-PM group to have a complication, with a 96% of probability. Conclusions TPS patients had a lower overall complication rate than VVI-PM patients including matched-pair samples using a Bayesian analysis. These results confirm the safety profile of TPS in clinical practice.

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Correlation of pacing site in right ventricle with paced QRS complex duration

Abstract: RV mid-septal and RVOT septal pacing were associated with significantly lower pQRS duration as compared with apical pacing. Based on multivariate analysis RVOT septal pacing appears to be preferred and more physiological pacing site.

Cited by 4 publications

References 21 publications

Wide complex tachycardia in a COVID-19 patient: What is the mechanism?

Wide complex tachycardia in a COVID-19 patient: What is the mechanism?

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Conventional single-chamber pacemakers versus transcatheter pacing systems in a “real world” cohort of patients: A comparative prospective single-center study

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