Electrocardiography of Multisite Ventricular Pacing

Garrigue, Stéphane; Barold, S. Serge; Clémenty, Jacques

doi:10.1002/9780470988404.ch8

Cited by 4 publications

(18 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 This requires having the patient connected to a multichannel 12lead ECG during the implantation procedure. 1,10,11 If both the native QRS and the biventricular paced complex are relatively narrow, then a widening of the paced QRS complex will identify loss of capture in one chamber with effectual capture in the other. (1) Intrinsic rhythm and QRS complex prior to any pacing.…”

Section: Ecg Patterns and Follow-up Of Biventricular Pacemakers 1128-30mentioning

confidence: 99%

“…[9][10][11] When there is intact capture in both the RV and LV, the evoked response on the ventricular electrogram will show a monophasic complex in contrast to the two distinct depolarizations during spontaneous AV conduction if the native QRS is wide (LBBB or left intraventricular conduction delay) (Fig. [9][10][11] When there is intact capture in both the RV and LV, the evoked response on the ventricular electrogram will show a monophasic complex in contrast to the two distinct depolarizations during spontaneous AV conduction if the native QRS is wide (LBBB or left intraventricular conduction delay) (Fig.…”

Section: First-generation Devices With a Common Outputmentioning

confidence: 99%

“…1,2,11 If the biventricular ECG is virtually similar to that recorded with RV or LV pacing alone and no cause is found, one should not automatically conclude that one of the leads does not contribute to biventricular depolarization without a detailed evaluation of the pacing system. Barring fusion beats, a narrower QRS implies depolarization from the RV and LV.…”

Section: Paced Qrs Duration and Status Of Mechanical Ventricular Resymentioning

confidence: 99%

“…Barring fusion beats, a narrower QRS implies depolarization from the RV and LV. 7,11,33 In other words, the degree of QRS narrowing or its absence does not correlate with the long-term hemodynamic benefit of biventricular pacing 7,11,33 because the paced QRS does not reflect the underlying level of mechanical dyssynchrony. 1,2,11 If the biventricular ECG is virtually similar to that recorded with RV or LV pacing alone and no cause is found, one should not automatically conclude that one of the leads does not contribute to biventricular depolarization without a detailed evaluation of the pacing system.…”

Section: Paced Qrs Duration and Status Of Mechanical Ventricular Resymentioning

confidence: 99%

“…Thus, measurement of QRS duration during follow-up is helpful in the analysis of appropriate biventricular capture and fusion with the spontaneous QRS. 7,11,34 Usefulness of the Frontal Plane Axis of the Paced QRS Complex Table 2 shows the importance of the frontal plane axis of the paced QRS complex in determining the arrangement of pacing during testing of biventricular pacemakers. So far, evaluation of the overall ECG patterns of biventricular pacing has focused on simultaneous RV and LV stimulation.…”

Section: Paced Qrs Duration and Status Of Mechanical Ventricular Resymentioning

confidence: 99%

See 4 more Smart Citations

Electrocardiographic Follow‐Up of Biventricular Pacemakers

Barold¹,

Herweg²,

Giudici³

2005

Noninvasive Electrocardiol

Self Cite

View full text Add to dashboard Cite

Multisite pacing for the treatment of heart failure has added a new dimension to the electrocardiographic evaluation of device function. During left ventricular (LV) pacing from the appropriate site in the coronary venous system, a correctly positioned lead V1 registers a right bundle branch block pattern with few exceptions. During biventricular stimulation associated with right ventricular (RV) apical pacing, the QRS is often positive in lead V1. The frontal plane QRS axis is usually in the right superior quadrant and occasionally in the left superior quadrant. Barring incorrect placement of lead V1 (too high on the chest), lack of LV capture, LV lead displacement or marked latency (exit block or delay from the stimulation site), ventricular fusion with the spontaneous QRS complex, a negative QRS complex in lead V1 during biventricular pacing involving the RV apex probably reflects different activation of an heterogeneous biventricular substrate (ischemia, scar, His-Purkinje participation in view of the varying patterns of LV activation in spontaneous left bundle branch block) and does not necessarily indicate a poor (electrical or mechanical) contribution from LV stimulation. In this situation, it is imperative to rule out the presence of coronary venous pacing via the middle cardiac vein or even unintended placement of two leads in the RV. During biventricular pacing with the RV lead in the outflow tract, the paced QRS in lead V1 is often negative and the frontal plane paced QRS axis is often directed to the right inferior quadrant (right axis deviation). In patients with sinus rhythm and a relatively short PR interval, ventricular fusion with competing native conduction during biventricular pacing may cause misinterpretation of the ECG because narrowing of the paced QRS complex simulates appropriate biventricular capture. This represents a common pitfall in device follow-up. Elimination of ventricular fusion by shortening the AV delay, is often associated with clinical improvement. Anodal stimulation may complicate threshold testing and should not be misinterpreted as pacemaker malfunction. One must be cognizant of the various disturbances that can disrupt 1:1 atrial tracking and cause loss of ventricular resynchronization. (1) Upper rate response. The upper rate response of biventricular pacemakers differs from the traditional Wenckebach upper rate response of conventional antibradycardia pacemakers because heart failure patients generally do not have sinus bradycardia or AV junctional conduction delay. The programmed upper rate should be sufficiently fast to avoid loss of resynchronization in situations associated with sinus tachycardia. (2) Below the programmed upper rate. This may be caused by a variety of events (especially ventricular premature complexes and favored by the presence of first-degree AV block) that alter the timing of sensed and paced events. In such cases, atrial events become trapped into the postventricular atrial refractory period at atrial rates below the programmed upper rate in the...

show abstract

Section: Ecg Patterns and Follow-up Of Biventricular Pacemakers 1128-30mentioning

confidence: 99%