Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices
Background: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing....
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| Format: | Artykuł |
| Język: | English |
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Elsevier
2018-01-01
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| Seria: | Indian Pacing and Electrophysiology Journal |
| Hasła przedmiotowe: | |
| Dostęp online: | http://www.sciencedirect.com/science/article/pii/S0972629217301468 |
| _version_ | 1830235288030412800 |
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| author | Amirfarjam Fazelifar Fatemeh Jorfi Majid Haghjoo |
| author_facet | Amirfarjam Fazelifar Fatemeh Jorfi Majid Haghjoo |
| author_sort | Amirfarjam Fazelifar |
| collection | DOAJ |
| description | Background: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing.
Purpose: This study was sought to determine different ECG patterns in patients with BiV pacing.
Methods: Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62.0 ± 13.5 years) with advanced heart failure and baseline left bundle branch block pattern after at least 6-month of uncomplicated CRT.
Results: During BiV pacing, 65% of the patients showed a dominant R wave in V1. There was a right axis deviation in 57% in frontal plane. However, a left superior axis emerged in 34% and normal frontal plane axis in 9%. Sequential BiV pacing (73% vs. 58%, P = 0.04) and pacing from posterolateral coronary vein (80% vs. 60%, p = 0.045) were more likely to present with a dominant R wave in V1. In sequential pacing, AV interval was significantly longer in patients with negative complex in V1 than in those with positive complex (124 ± 21 vs. 116 ± 8.0, p = 0.005). A Q/q wave was detected in 85% of patients in lead I and 78% in lead aVL.
Conclusions: BiV pacing from lateral coronary venous branches and right ventricular apex characteristically presented with dominant R wave in V1, Q/q wave in leads I and aVL, and right or left superior axis. However, a negative complex in V1, QRS axis in other quadrants, and lack of Q/q wave in leads I and aVL did not necessarily indicate a problem. |
| first_indexed | 2024-12-18T12:26:27Z |
| format | Article |
| id | doaj.art-c88db2d9037e43dabcea06dc3e8af0f5 |
| institution | Directory Open Access Journal |
| issn | 0972-6292 |
| language | English |
| last_indexed | 2024-12-18T12:26:27Z |
| publishDate | 2018-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Pacing and Electrophysiology Journal |
| spelling | doaj.art-c88db2d9037e43dabcea06dc3e8af0f52022-12-21T21:08:14ZengElsevierIndian Pacing and Electrophysiology Journal0972-62922018-01-01181131910.1016/j.ipej.2017.10.007Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devicesAmirfarjam Fazelifar0Fatemeh Jorfi1Majid Haghjoo2Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IranCardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IranCardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IranBackground: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing. Purpose: This study was sought to determine different ECG patterns in patients with BiV pacing. Methods: Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62.0 ± 13.5 years) with advanced heart failure and baseline left bundle branch block pattern after at least 6-month of uncomplicated CRT. Results: During BiV pacing, 65% of the patients showed a dominant R wave in V1. There was a right axis deviation in 57% in frontal plane. However, a left superior axis emerged in 34% and normal frontal plane axis in 9%. Sequential BiV pacing (73% vs. 58%, P = 0.04) and pacing from posterolateral coronary vein (80% vs. 60%, p = 0.045) were more likely to present with a dominant R wave in V1. In sequential pacing, AV interval was significantly longer in patients with negative complex in V1 than in those with positive complex (124 ± 21 vs. 116 ± 8.0, p = 0.005). A Q/q wave was detected in 85% of patients in lead I and 78% in lead aVL. Conclusions: BiV pacing from lateral coronary venous branches and right ventricular apex characteristically presented with dominant R wave in V1, Q/q wave in leads I and aVL, and right or left superior axis. However, a negative complex in V1, QRS axis in other quadrants, and lack of Q/q wave in leads I and aVL did not necessarily indicate a problem.http://www.sciencedirect.com/science/article/pii/S0972629217301468ElectrocardiogramBiventricular pacingCardiac resyncronization |
| spellingShingle | Amirfarjam Fazelifar Fatemeh Jorfi Majid Haghjoo Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices Indian Pacing and Electrophysiology Journal Electrocardiogram Biventricular pacing Cardiac resyncronization |
| title | Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices |
| title_full | Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices |
| title_fullStr | Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices |
| title_full_unstemmed | Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices |
| title_short | Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices |
| title_sort | electrocardiographic patterns in biventricular pacing delivered by second generation cardiac resynchronization devices |
| topic | Electrocardiogram Biventricular pacing Cardiac resyncronization |
| url | http://www.sciencedirect.com/science/article/pii/S0972629217301468 |
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