Electrocardiographic Diagnosis of Biventricular Pacing in Patients with Nonapical Right Ventricular Leads

Abstract

The study identified QRS features that were very specific for BiV pacing in patients with nonapical RV leads. Sequential arrangement of those features resulted in an algorithm that was very accurate for differentiating between BiV pacing and loss of LV capture.

Renewed interest in the significance of the tall R wave in ECG lead V1 during right ventricular pacing

“…In our evaluation of over 100 cases, we found that RV outflow or septal pacing invariably generates a left bundle branch block (LBBB) pattern in the precordial leads so that there is no dominant R wave in lead V1 or V2 [17]. Jastrzebski et al [1] found 0% dominant R waves in V1 in 150 patients with nonapical RV pacing implanted according to the methods of Mond and Vlay [18]. As indicated Tzeis et al [4] found a RBBB pattern in 1.9% of patients with RV midseptal pacing.…”

“…Several recent articles have renewed interest in the significance of a dominant R wave in ECG lead V1 during right ventricular (RV) pacing [1][2][3][4]. A dominant R wave in V1 (R/ S > 1) during RV pacing is often called a 'right bundle branch block' (RBBB) pattern, but this terminology is potentially misleading because this configuration actually reflects activation moving from the posterior to the anterior part of the heart [5].…”

Cost Minimization Using an Artificial Neural Network Sleep Apnea Prediction Tool for Sleep Studies

“…All comparisons of the diagnostic performance of the three prediction tools using the previously described methodologies were accomplished with BDTcomparator software (http://code.google.com/p/ bdtcomparator/) (30)(31)(32). All P values were adjusted for multiple comparisons, using Holm's procedure (33).…”

Reappraisal of ECG Lead V1 in the Assessment of Cardiac Resynchronization

“…The 2012 EHRA/HRS (European Heart Rhythm Association/Heart Rhythm Society) Expert Consensus has stated that “a dominant R wave in V1 is almost invariably present in successful cardiac resynchronization therapy. It follows that a negative paced QRS complex in V1 should prompt full investigation.” Many workers have used an R/S > 1 with or without an equiphasic QRS complex (R/S = 1) to define a dominant R wave in lead V1 . A dominant R wave in lead V1 has also been called a right bundle branch block (RBBB), though it is caused by anterior displacement of the QRS forces rather than a right‐sided conduction delay .…”

“…Lead V1 provides useful information about the timing between left ventricular (LV) and right ventricular (RV) electrical activity, and it constitutes an integral part of some algorithms for the detection of successful LV capture . Yet, studies focusing on the dominant R wave in V1 during cardiac resynchronization therapy (CRT) have reported an incidence of a dominant R wave in 25–100% for LV leads implanted predominantly in the posterior or posterolateral cardiac veins . Why is the incidence of a dominant R wave in lead V1 so variable?…”