George Andrikopoulos1, Stylianos Tzeis2, Stefan Asbach3, Verena Semmler4, Carsten Lennerz4, Ulrich Solzbach5, Christian Grebmer4, Axel Kloppe6, Norbert Klein7, Socratis Pastromas2, Jürgen Biermann3, Christof Kolb4. 1. Department of Cardiology, Henry Dunant Hospital, 107 Mesogion Avenue, Athens 115 26, Greece andrikop@hotmail.com. 2. Department of Cardiology, Henry Dunant Hospital, 107 Mesogion Avenue, Athens 115 26, Greece. 3. Department of Cardiology and Angiology I, Heart Centre Freiburg University, Freiburg, Germany. 4. Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany. 5. Ostalbklinikum, Abteilung für Innere Medizin II, Aalen, Germany. 6. Klinikum Lüdenscheid, Abteilung für Innere Medizin III, Lüdenscheid, Germany Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II, Ruhr Universität Bochum, Bochum, Germany. 7. Universitätsklinikum Leipzig, Abteilung für Kardiologie und Angiologie, Leipzig, Germany.
Abstract
AIMS: Right ventricular (RV) septum is a non-apical site targeted during lead implantation. Electrocardiographic (ECG) recognition of mid-septal lead location is challenging. The aim of the study is to determine ECG correlates of RV mid-septal pacing. METHODS AND RESULTS: The present study is a pre-specified analysis of a prospective, multicenter study, which randomized recipients of an implantable cardioverter defibrillator to an apical vs. mid-septal RV lead positioning. Following implantation, a 12-lead ECG was recorded during intrinsic rhythm and RV pacing. In total, 227 patients, 121 in the apical group (76.9% males, 67.1 ± 11.3 years) and 106 in the mid-septal group (82.1% males, age 64.7 ± 12.7 years) were included. Apically as compared with septally paced patients had significantly longer paced QRS duration (177.0 ± 25.0 vs. 170.4 ± 21.7, respectively, P = 0.03) and significantly more leftward paced QRS axis (-71.6 ± 33.3° vs. 9.4 ± 86.5°, respectively, P < 0.001). A significantly higher proportion of patients in the mid-septal as compared with the apical group displayed predominantly positive QRS in lead V6 (62.3 vs. 4.1%, P < 0.001), predominantly positive QRS in any of the inferior leads (53.8 vs. 4.1%, P < 0.001), and a QR pattern in lead aVL (53.3 vs. 3.3%, P < 0.001). These ECG correlates were incorporated in a stepwise algorithm with total sensitivity of 87% and specificity of 90% for the identification of a mid-septal lead location. CONCLUSION: A mid-septal lead location may be identified using a simple stepwise algorithm, based on the presence of positive QRS in lead V6, positive QRS in any of the inferior leads, and a QR pattern in lead aVL. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: Right ventricular (RV) septum is a non-apical site targeted during lead implantation. Electrocardiographic (ECG) recognition of mid-septal lead location is challenging. The aim of the study is to determine ECG correlates of RV mid-septal pacing. METHODS AND RESULTS: The present study is a pre-specified analysis of a prospective, multicenter study, which randomized recipients of an implantable cardioverter defibrillator to an apical vs. mid-septal RV lead positioning. Following implantation, a 12-lead ECG was recorded during intrinsic rhythm and RV pacing. In total, 227 patients, 121 in the apical group (76.9% males, 67.1 ± 11.3 years) and 106 in the mid-septal group (82.1% males, age 64.7 ± 12.7 years) were included. Apically as compared with septally paced patients had significantly longer paced QRS duration (177.0 ± 25.0 vs. 170.4 ± 21.7, respectively, P = 0.03) and significantly more leftward paced QRS axis (-71.6 ± 33.3° vs. 9.4 ± 86.5°, respectively, P < 0.001). A significantly higher proportion of patients in the mid-septal as compared with the apical group displayed predominantly positive QRS in lead V6 (62.3 vs. 4.1%, P < 0.001), predominantly positive QRS in any of the inferior leads (53.8 vs. 4.1%, P < 0.001), and a QR pattern in lead aVL (53.3 vs. 3.3%, P < 0.001). These ECG correlates were incorporated in a stepwise algorithm with total sensitivity of 87% and specificity of 90% for the identification of a mid-septal lead location. CONCLUSION: A mid-septal lead location may be identified using a simple stepwise algorithm, based on the presence of positive QRS in lead V6, positive QRS in any of the inferior leads, and a QR pattern in lead aVL. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Martin van Zyl; Chance M Witt; Subir Bhatia; Majd Khasawneh; Prakriti Gaba; Charles J Lenz; Andrew N Rosenbaum; Htin Aung; David O Hodge; Christopher J McLeod; Samuel J Asirvatham Journal: Indian Pacing Electrophysiol J Date: 2019-03-08