AIMS: A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing site. Although this could be achieved by continual 12-Lead ECG monitoring, such a technique is not applicable during pacemaker (PM) implantation. The purpose of this study was to validate a method for identifying the optimal site for RV septum pacing using simple markers derived from few real-time ECG leads and fluoroscopy (F). METHODS AND RESULTS: An overall of 304 measurements of pQRSd in different RV sites was performed in 102 patients undergoing PM implant. In accordance with F position the lead placement was classified high, medium, and low septum. Paced electrocardiographic/fluoroscopic parameters (q-wave/negative QRS in lead I, notching in limb leads, R/S wave in lead II, QRS precordial leads transition, and F septal segments pacing site) were analyzed to predict short pQRSd (≤ 160 ms). Logistic regression analysis showed that pQRSd > 160 ms was predicted by presence of pQRS notching in limb leads (OR = 3.24, p < 0.001), and with negative amplitude of QRS in lead II (OR = 2.53, p = 0.03). Short pQRSd (≤ 160 ms) was observed with mid F position (OR = 0.31, p < 0.001) and with the presence of a q-wave/negative QRS in lead I. CONCLUSION: In RV septum pacing, simple QRS markers of few limb leads (lead I/II) added to F position are usefull to identifying the optimal site to place the RV lead.
AIMS: A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing site. Although this could be achieved by continual 12-Lead ECG monitoring, such a technique is not applicable during pacemaker (PM) implantation. The purpose of this study was to validate a method for identifying the optimal site for RV septum pacing using simple markers derived from few real-time ECG leads and fluoroscopy (F). METHODS AND RESULTS: An overall of 304 measurements of pQRSd in different RV sites was performed in 102 patients undergoing PM implant. In accordance with F position the lead placement was classified high, medium, and low septum. Paced electrocardiographic/fluoroscopic parameters (q-wave/negative QRS in lead I, notching in limb leads, R/S wave in lead II, QRS precordial leads transition, and F septal segments pacing site) were analyzed to predict short pQRSd (≤ 160 ms). Logistic regression analysis showed that pQRSd > 160 ms was predicted by presence of pQRS notching in limb leads (OR = 3.24, p < 0.001), and with negative amplitude of QRS in lead II (OR = 2.53, p = 0.03). Short pQRSd (≤ 160 ms) was observed with mid F position (OR = 0.31, p < 0.001) and with the presence of a q-wave/negative QRS in lead I. CONCLUSION: In RV septum pacing, simple QRS markers of few limb leads (lead I/II) added to F position are usefull to identifying the optimal site to place the RV lead.
Authors: Oscar Cano; Joaquín Osca; María-José Sancho-Tello; Juan M Sánchez; Víctor Ortiz; José E Castro; Antonio Salvador; José Olagüe Journal: Am J Cardiol Date: 2010-03-30 Impact factor: 2.778
Authors: Himanshu H Shukla; Anne S Hellkamp; Erskine A James; Greg C Flaker; Kerry L Lee; Michael O Sweeney; Gervasio A Lamas Journal: Heart Rhythm Date: 2005-03 Impact factor: 6.343