Clinical Significance of QRS Duration During Ventricular Pacing

Sumiyoshi, Masataka; Nakata, Yasuro; Tokano, Takashi; Yasuda, Masayuki; Ohno, Yasuhiko; Hisaoka, Teruhiko; Ogura, Shunsuke; Nakazato, Yuji; Yamaguchi, Hiroshi

doi:10.1111/j.1540-8159.1992.tb03099.x

Cited by 18 publications

(11 citation statements)

References 10 publications

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“…19 The Q-LV interval was defined as the interval from the onset of the intrinsic QRS on the surface ECG to the first large positive or negative peak of the LV electrogram ( Figure 1). The amplitude of the first large peak needed to be >50% of the amplitude of the largest peak in the same cardiac cycle.…”

Section: Electrophysiology Laboratory Measurementsmentioning

confidence: 99%

Determination of the Longest Intrapatient Left Ventricular Electrical Delay May Predict Acute Hemodynamic Improvement in Patients After Cardiac Resynchronization Therapy

Zanon

Baracca

Pastore

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. Methods and Results-Thirty-two consecutive patients (23 men; mean age, 71±11 years; LV ejection fraction, 30±6%; 18 with ischemic cardiomyopathy; QRS, 181±25 ms; all mean±SD) underwent cardiac resynchronization therapy device implantation. All available tributary veins of the coronary sinus were tested, and the Q-LV interval was measured at each pacing site. The hemodynamic effects of pacing at different sites were evaluated by invasive measurement of LV dP/dt max at baseline and during pacing. Overall, 2.9±0.8 different veins and 6.4±2.3 pacing sites were tested. In 31 of 32 (96.8%) patients, the highest LV dP/dt max coincided with the maximum Q-LV interval. Q-LV interval correlated with the increase in LV dP/dt max in all patients at each site (AR1 ρ=0.98; P<0.001). A Q-LV value >95 ms corresponded to a >10% in LV dP/dt max . An inverse correlation between paced QRS duration and improvement in LV dP/dt max was seen in 24 patients (75%). Conclusions-Pacing the LV at the latest activated site is highly predictive of the maximum increase in contractility, expressed as LV dP/dt max . A positive correlation between Q-LV interval and hemodynamic improvement was found in all patients at every pacing site, a value of 95 ms corresponding to an increase in LV dP/dt max of ≥10%. (Circ Arrhythm Electrophysiol. 2014;7:377-383.)Key Words: cardiac resynchronization therapy ◼ cardiomyopathies ◼ heart failure ◼ hemodynamics Received July 11, 2013; accepted March 14, 2014. interval-the interval from the onset of the intrinsic QRS on the surface ECG to the first large peak of the LV electrogram) and hemodynamics was derived from single measurements in each patient and, therefore, cannot be extrapolated to the use of Q-LV interval within an individual patient. The aims of our study were to investigate acute hemodynamic improvement during LV pacing from all available sites within a patient, as well as to test the hypothesis that the region with the longest electric delay provides the best hemodynamic response. MethodsWe analyzed the relationship between LV dP/dt max increase and LV electric delay in a CRT population. The study was approved by the local ethics board, and all patients provided written informed consent.In accordance with our standard implantation procedure, the right ventricular and atrial leads were positioned in conventional sites in all patients. Specifically, the right ventricular leads were implanted in the midseptum. The coronary sinus was cannulated via a telescopic approach, as previously described 18 ; coronary sinus angiography was performed, and all suitable collateral veins were subcannulated and visualized selectively. For the purpose of the present article, we def...

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Section: Electrophysiology Laboratory Measurementsmentioning

confidence: 99%

Determination of the Longest Intrapatient Left Ventricular Electrical Delay May Predict Acute Hemodynamic Improvement in Patients After Cardiac Resynchronization Therapy

Zanon

Baracca

Pastore

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…The relationship between paced QRS duration in patients with RV apex pacing and heart function has been identified in previous studies. 19,20) Sumiyoshi et al reported that a paced QRS duration =180 msec was sensitive and specific for a left ventricular ejection fraction <50% and left ventricular diastolic dimension =60 mm. 19) Miyoshi et al pointed out that the definition of an abnormal prolonged QRS duration =190 ms should be appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…19,20) Sumiyoshi et al reported that a paced QRS duration =180 msec was sensitive and specific for a left ventricular ejection fraction <50% and left ventricular diastolic dimension =60 mm. 19) Miyoshi et al pointed out that the definition of an abnormal prolonged QRS duration =190 ms should be appropriate. 20) However, there were no any reports evaluated the QRS duration of patients with RBBB pattern during RV apex pacing.…”

Section: Discussionmentioning

confidence: 99%

Clinical Meaning of Right Bundle Branch Block Pattern on Surface Electrocardiogram in Pacemaker Patients During Right Ventricular Endocardial Pacing

Abula¹,

Goseki²,

Arata³

et al. 2009

J Arrhythmia

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Introduction: Right bundle branch block (RBBB) pattern is sometimes observed in right ventricular (RV) endocardial pacing. However, the true mechanism and the clinical meaning of this phenomenon are still unknown.Methods and results: Out of 218 consecutive patients with RV apex endocardial pacing, we studied 30 cases with RBBB pattern and 111 cases with left bundle branch block (LBBB) pattern. No significant differences were found between these 2 groups in age, sex, and pacing mode. However, the percentage of cardiomyopathy patients in the RBBB pattern group was significantly higher than in the LBBB pattern group (36.7% versus 1.8%, p < 0:0001). The left ventricular diastolic dimension (52:2 AE 9:3 mm versus 48:0 AE 5:5 mm, p ¼ 0:05) was bigger and left ventricular ejection fraction (56:2 AE 14:7% versus 66:4 AE 11:6%, p ¼ 0:0003) was lower in the RBBB pattern group. In RBBB pattern group, 11 out of 13 patients with low cardiac function (ejection fraction <50%) showed a wide QRS duration greater than 160 ms in V1 and II leads.Conclusions: RBBB pattern, especially QRS duration wider than 160 ms in V1 and II leads, during RV endocardial pacing may represent left ventricular enlargement and dysfunction. These findings would help assess the cardiac function based on surface 12-lead electrocardiography even in RV pacing. (J Arrhythmia 2009; 25: 16-23)

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“…Sumiyoshi et al9) studied 114 patients who had undergone pacing for atrioventricular block. The patients were divided into one group with paced QRS duration of more than 180 ms and a second group with paced QRS duration of less than 180 ms.…”

Section: Discussionmentioning

confidence: 99%

“…Sumiyoshi et al9). reported that patients with an extended paced QRS duration tend to exhibit more serious heart disease, and the paced QRS duration can be an invaluable indicator of impaired left ventricular function.…”

Section: Introductionmentioning

confidence: 99%

The Effects of QRS Duration and Pacing Sites on the Acute Hemodynamic Changes during Right Ventricular Pacing

Hong

Yang

Sim

et al. 2005

Korean J Intern Med

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BackgroundHas been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown.MethodsA total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized.ResultsDuring RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r=0.500, p=0.001), the change of QRS duration post-pacing (r=0.426, p=0.001), and SBP during sinus rhythm (r=0.342, p=0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing.ConclusionVentricular pacing of less than 40 ms at the area of paced QRS duration is recommended.

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Clinical Significance of QRS Duration During Ventricular Pacing

Cited by 18 publications

References 10 publications

Determination of the Longest Intrapatient Left Ventricular Electrical Delay May Predict Acute Hemodynamic Improvement in Patients After Cardiac Resynchronization Therapy

Determination of the Longest Intrapatient Left Ventricular Electrical Delay May Predict Acute Hemodynamic Improvement in Patients After Cardiac Resynchronization Therapy

Clinical Meaning of Right Bundle Branch Block Pattern on Surface Electrocardiogram in Pacemaker Patients During Right Ventricular Endocardial Pacing

The Effects of QRS Duration and Pacing Sites on the Acute Hemodynamic Changes during Right Ventricular Pacing

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