Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing

Abstract

Introduction The electrocardiograms (ECG) criteria to anchor the lead to the right ventricular septum have not been established. This study aimed to identify ECG criteria of pacing at the right ventricular mid septum (RVMS) and investigate whether the paced QRS duration (pQRSd) from the RVMS was narrow. Methods and results In 42 patients, ECG pacing at the basal anterior wall (BA), mid‐anterior wall (MA), apex (AP), and mid septum (MS) was recorded. The pacing sites were validated by using right ventriculography and computed tomography. We estimated the ECG parameters and compared them among the four pacing sites. The combination of simple four paced‐ECG parameters could reliably confirm the pacing at the RVMS. The area under the receiver‐operating characteristics curve for the number of positive findings among the following: (a) positive QRS in lead aVL, (b) QRS notching in lead I, (c) precordial leads transition at less than V5, and (d) presence of isoelectric QRS in the inferior leads was 0.95 (95% confidence interval, 0.91‐0.98) and the number of positive findings (≥3) had a sensitivity of 83.3% and a specificity of 93.7% for discriminating MS from the other sites. The pQRSd with three or more positive findings was significantly narrower than that with less than three positive findings (≥3: 137.4 ± 9.2 ms, <3: 151.8 ± 13.1 ms, P ≤ .05). Conclusion The combination of ECG parameters can help identify right ventricular mid‐septal pacing. The use of these parameters may enable the implantation of the pacing lead in the RVMS accurately and obtain a narrower QRS duration.

Risk factors of pacing‐induced cardiomyopathy—Insights from lead position

“…On the other hand, the paced QRS duration is reportedly shorter in the mid‐RVSP than that in the RVAP. 12 , 13 Therefore, studies have been conducted on whether PICM could be prevented by RVSP. Kaye et al randomly assigned patients with severe atrioventricular block to RVAP or RV high septum (RVHS) pacing groups and followed them for 2 years, reporting no significant difference in left ventricular function between the two groups.…”

“…On the other hand, the paced QRS duration is reportedly shorter in the mid-RVSP than that in the RVAP. 12,13 Therefore, studies have been conducted on whether PICM could be prevented by RVSP.…”

“…We previously demonstrated that mid‐RVSP results in the shortest‐paced QRS duration in the RV. 12 The present study investigated the predictors of PICM among the patients who underwent PM implantation with lead in RVA or mid‐RVS confirmed by CT. This study aimed to elucidate the potential difference in the incidence of PICM between RVAP and “true” mid‐RVSP and to identify factors that could predict PICM.…”

Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)?

“…Para confirmar a PHP (grupo DDD-Var), buscou-se o complexo QRS estimulado mais estreito (até 130 ms e sempre < 150 ms) através do mapeamento do septo IV pelo eletrodo ventricular 21 previamente à liberação do screw-in. Simultaneamente, em tempo real (intraoperatório), sob estimulação VVI decrementando desde amplitude = 5 V e largura de pulso = 1 ms, o sistema de análise da variância espacial do QRS -dispositivo Synchromax® (Exo S.A. Argentina) -mostrava o índice imediato de sincronia (IimeS).…”

“…12,22,23 Valores de IimeS < 0,40 são considerados normais (sincrônico); valores de IimeS > 0,41 e < 0,69 são considerados dissincronia moderada; e valores de IimeS > 0,7 são considerados dissincronia severa (Figura 2B). 11,19,21 A abordagem e a captura do feixe de His (grupo DDD-His) foram feitas através de duas vias. Uma através da introdução femoral de cateter quadripolar para mapeamento eletrofisiológico e registro do potencial elétrico de His.…”