A stepwise electrocardiographic algorithm for differentiation of mid-septal vs. apical right ventricular lead positioning: the SPICE ECG substudy

Andrikopoulos, George; Tzeis, Stylianos; Asbach, Stefan; Semmler, Verena; Lennerz, Carsten; Solzbach, U.; Grebmer, Christian; Kloppe, Axel; Klein, N.; Pastromas, Sokratis; Biermann, Julia; Kolb, Christof

doi:10.1093/europace/euu344

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Besides, extra pacing lead meant higher risk of device related complication and more medical expense, therefore clinician should pay attention to these potential problems. Considering the equal efficacy of implantable cardioverter defibrillator (ICD) electrode positioned to either septum or apex [ 46 – 48 ], leads of HBRP and ICD could be then integrated. Furthermore, QRS duration in some patients with LBBB wasn’t shortened by HBRP because of infra-His bundle block close to branch bundles [ 17 , 49 ], and hence, distal His bundle pacing should be preferred for fear of His bundle block in proximal and medial sites.…”

Section: Discussionmentioning

confidence: 99%

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Chen

et al. 2017

BMC Cardiovasc Disord

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BackgroundLong-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP).MethodsPublished studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis.ResultsHBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% – 6.1%), lower NYHA class (WMD = −0.5, 95% CI: -0.7 – -0.3), WMD of LVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml), less inter-ventricular asynchrony (WMD = −13.2 ms, 95% CI: -16.4 – -10.0 ms), and shorter QRS duration for long-term (WMD = −36.9 ms, 95% CI: -40.0 – -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = −2.4 ml, 95% CI: -5.0 – 0.2 ml; WMDLVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml) compared to RVP.ConclusionsThe efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0649-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Chen

et al. 2017

BMC Cardiovasc Disord

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“…ECG criteria have been studied previously and led to highly variable conclusions, [2][3][4]10,14,15 rendering its use subject to caution for RV lead positioning. However, the inaccuracy of the classical fluoroscopy criteria has also been previously shown in several studies, using either TTE 2 or computed tomography scan 3,4 as a reference.…”

Section: Flaws Of the Usual Per-procedural Tools For Targeting The Rvmentioning

confidence: 99%

Individualized Left Anterior Oblique Projection

Squara

Scarlatti

Riccini

et al. 2018

Circ: Arrhythmia and Electrophysiology

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BACKGROUND:Classical fluoroscopic criteria for the documentation of septal right ventricular (RV) lead positioning have poor accuracy. We sought to evaluate the individualized left anterior oblique (LAO) projection as a novel fluoroscopy criterion. METHODS:Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead positioning was assessed by fluoroscopy using posteroanterior, right anterior oblique 30° to rule out coronary sinus positioning, and LAO 40° in the classical group or individualized LAO in the individualized group. Individualized LAO was defined by the degree of LAO that allowed the perfect superposition of the RV apex (using the tip of the RV lead temporarily placed at the apex) and of the superior vena cava-inferior vena cava axis (materialized by a guidewire), hence providing a true profile view of the interventricular septum. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with true RV lead positioning using transthoracic echocardiography. RESULTS:We included 100 patients, 50 in each study group. Agreement between RV lead septal/free wall positioning in transthoracic echocardiography and fluoroscopy was excellent in the individualized group (k=0.91), whereas it was poor in the classical group (k=0.35). Septal/free wall RV lead positioning was correctly identified in 48/50 (96%) patients in the individualized group versus 38/50 (76%) in the classical group (P=0.004). For septal lead positioning, fluoroscopy had 100% Se and 89.5% Sp in the individualized group versus 91.4% Se and 40% Sp in the classical group. Complications and procedural data were comparable in both groups. CONCLUSION:Individualized LAO is a quick and highly reliable patienttailored fluoroscopy projection for RV lead positioning.

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“…Negative or isoelectric QRS in lead I 5,7,8 QRS duration <140 ms 5,8 QRS axis less than −30̊9 Early QRS transition (V4 or earlier) 16 Inferior leads positive 7,8 Absence of inferior lead notching [6][7][8]16 Negative aVL 9 Positive QRS lead V6 9 ECG = electrocardiogram; RV = right ventricular.…”

Section: Previously Published 12-lead Ecg Criteria Associated With Rvmentioning

confidence: 99%

“…Placing a lead at the RV septum ideally involves using a shaped stylet together with fluoroscopy in the anteroposterior (AP) and the left anterior oblique (LAO) 30–40° position and some advocate 10–30° right anterior oblique, sometimes in combination with a surface electrocardiogram (ECG) . Although there have been previously published ECG criteria to assist in defining lead position in the RVS (Table ), there is currently no standardized internationally accepted methodology for defining postimplantation lead position . Previous studies which have attempted to characterize ECG features associated with septal pacing have done so based on fluoroscopic or postimplant x‐ray determination of lead position .…”

Section: Introductionmentioning

confidence: 99%

“…2 Although there have been previously published ECG criteria to assist in defining lead position in the RVS (Table I), there is currently no standardized internationally accepted methodology for defining postimplantation lead position. [5][6][7][8][9] Previous studies which have attempted to characterize ECG features associated with septal pacing have done so based on fluoroscopic or postimplant x-ray determination of lead position. 5 Recent studies using high-resolution computed tomography (CT) scanning have determined that fluoroscopy can be inaccurate and therefore ©2017 Wiley Periodicals, Inc.…”

Section: Introductionmentioning

confidence: 99%

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Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT

Rowe

Moore

Pratap

et al. 2017

Pacing Clinical Electrophis

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A stepwise electrocardiographic algorithm for differentiation of mid-septal vs. apical right ventricular lead positioning: the SPICE ECG substudy

Abstract: 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.

Cited by 9 publications

References 18 publications

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Individualized Left Anterior Oblique Projection

Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT

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