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. 2018 Nov-Dec;18(6):210-216.
doi: 10.1016/j.ipej.2018.08.001. Epub 2018 Aug 17.

Correlation of pacing site in right ventricle with paced QRS complex duration

Anunay Gupta  1 , Neeraj Parakh  2 , Raghav Bansal  1 , Sunil K Verma  1 , Ambuj Roy  1 , Gautam Sharma  1 , Rakesh Yadav  1 , Nitish Naik  1 , Rajnish Juenja  1 , Vinay K Bahl  1
Affiliations

Correlation of pacing site in right ventricle with paced QRS complex duration

Anunay Gupta et al. Indian Pacing Electrophysiol J. 2018 Nov-Dec.

Abstract

Background: Pacing from RV mid septum and outflow tract septum has been proposed as a more physiological site of pacing and narrower paced QRS complex duration. The paced QRS morphology and duration in different RV pacing sites is under continued discussion. Hence, this study was designed to address the correlation of pacing sites in right ventricle with paced QRS complex duration.

Methods: Two hundred fifty-two consecutive patients who underwent pacemaker implantation were enrolled. Baseline clinical characteristics were recorded for each patient. All patient underwent fluoroscopy, electrocardiogram and echocardiography post pacemaker implantation. Paced QRS duration was calculated from the leads with maximum QRS duration.

Results: Mean paced QRS (pQRS) duration was significantly higher in apical septum group with a mean of 148.9 ± 14.8 m s compared to mid septum (139.6 ± 19.9 m s; p-value 0.003) and RVOT septum (139.6 ± 14.8 m s; p-value 0.002) groups, respectively. There was no significant difference between mid-septal and RVOT septal pQRS duration. On multivariate analysis, female gender, baseline QRS duration and RVOT septal pacing were the only predictors for narrow pQRS duration (<150 msec).

Conclusion: RV mid-septal and RVOT septal pacing were associated with significantly lower pQRS duration as compared with apical pacing. Based on multivariate analysis RVOT septal pacing appears to be preferred and more physiological pacing site.

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Figures

Fig. 1
Fig. 1
Study flow chart.
Fig. 2
Fig. 2
Anteroposterior (A), 40° Left anterior oblique (B), 30° RAO (C) and left lateral (D) fluoroscopic images showing right ventricular lead tip at apical septum in a patient with dual chamber pacemaker. Twelve lead electrocardiogram of RV apical pacing, ECG showing superior axis with broad pQRS duration of 155 msec (E).
Fig. 3
Fig. 3
Anteroposterior (A), 40° Left anterior oblique (B), 30° RAO (C) and left lateral (D) fluoroscopic images showing right ventricular lead tip at mid septum in a patient with single chamber pacemaker. Twelve lead electrocardiogram of mid septal pacing showing narrow pQRS duration of 94 msec and normal axis (E).
Fig. 4
Fig. 4
Anteroposterior (A), 40° Left anterior oblique (B), 30° RAO (C) and left lateral (D) fluoroscopic images showing lead tip at RVOT septum in a patient with single chamber pacemaker. In left lateral position lead tip is being seen at posterior orientation confirmed it to be on the true RVOT septum. Twelve lead electrocardiogram of RVOT pacing showing inferior axis with narrow pQRS duration of 102 msec (E).
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