Karol Curila1, Pavel Jurak2, Josef Halamek2, Frits Prinzen3, Petr Waldauf4, Jakub Karch1, Petr Stros1, Filip Plesinger2, Jan Mizner1, Marketa Susankova1, Radka Prochazkova1, Ondrej Sussenbek1, Ivo Viscor2, Vlastimil Vondra2, Radovan Smisek2,5, Pavel Leinveber6, Pavel Osmancik1. 1. Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. 2. Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czech Republic. 3. Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands. 4. Department of Anesthesia and Intensive Care, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. 5. Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic. 6. International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
Abstract
BACKGROUND: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra-high-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations. METHODS: In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay). RESULTS: The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them. CONCLUSION: RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.
BACKGROUND: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra-high-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations. METHODS: In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay). RESULTS: The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them. CONCLUSION: RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.
Authors: Pavel Jurak; Laura R Bear; Uyên Châu Nguyên; Ivo Viscor; Petr Andrla; Filip Plesinger; Josef Halamek; Vlastimil Vondra; Emma Abell; Matthijs J M Cluitmans; Rémi Dubois; Karol Curila; Pavel Leinveber; Frits W Prinzen Journal: Sci Rep Date: 2021-06-01 Impact factor: 4.379
Authors: Karol Curila; Pavel Jurak; Kevin Vernooy; Marek Jastrzebski; Petr Waldauf; Frits Prinzen; Josef Halamek; Marketa Susankova; Lucie Znojilova; Radovan Smisek; Jakub Karch; Filip Plesinger; Pawel Moskal; Luuk Heckman; Jan Mizner; Ivo Viscor; Vlastimil Vondra; Pavel Leinveber; Pavel Osmancik Journal: Front Cardiovasc Med Date: 2021-12-07