Document Detail


The paced electrocardiogram cannot be used to identify left and right ventricular pacing sites in cardiac resynchronization therapy: validation by cardiac computed tomography.
MedLine Citation:
PMID:  25480941     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIMS: Paced electrocardiogram characteristics to confirm left ventricular (LV) and right ventricular (RV) pacing sites in cardiac resynchronization therapy (CRT) have not been validated with accurate knowledge of pacing lead positions. We aimed to evaluate the ability of the paced QRS morphology to differentiate between various LV and RV lead positions using cardiac computed tomography (CT) as the reference for LV and RV pacing site.
METHODS AND RESULTS: Ninety-seven CRT patients were included. The QRS morphology was evaluated during forced LV-only and RV-only pacing. Pacing lead positions were assessed in a standard LV 16-segment model and a simplistic RV 6-segment model using cardiac CT. Ten patients with LV lead displacement or a LV pacing site outside the non-apical free wall were excluded from the analysis of the LV paced QRS complex. Pacing within the LV free wall was associated with a superior and a right-axis deviation (P = 0.02 and 0.04, respectively). Pacing from basal LV segments mainly produced a late (V5 or later) precordial QRS transition as compared with mid-LV pacing (P = 0.001). No significant associations were found between RV pacing site and QRS axis or precordial transition. Different QRS morphologies were observed during single-chamber pacing from identical LV or RV myocardial segments.
CONCLUSION: Weak associations exist between LV and RV pacing sites and the paced QRS axis. None of the paced QRS characteristics can be used to reliably confirm specific LV and RV pacing sites in CRT patients.
Authors:
Anders Sommer; Mads Brix Kronborg; Christoffer Tobias Witt; Bjarne Linde Nørgaard; Jens Cosedis Nielsen
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-12-5
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2014 Dec 
Date Detail:
Created Date:  2014-12-6     Completed Date:  -     Revised Date:  2014-12-7    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.
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