Intraventricular conduction disturbances after correction of tetralogy of Fallot: Can bifascicular and trifascicular block be diagnosed from the surface ECG?

1985 ◽  
Vol 6 (3) ◽  
pp. 133-136 ◽  
Author(s):  
Beat Friedli ◽  
Marc Bolens
Keyword(s):  
Tetralogy Of Fallot ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Surface Ecg

scholarly journals Electrocardiographic characterization of non-selective His bundle pacing. Validation of novel diagnostic criteria

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Karol Curila ◽  
Kamil Fijorek ◽  
Piotr Kukla ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Left Ventricular ◽  
Peak Time ◽  
List Type ◽  
Intraventricular Conduction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disturbances ◽  
Surface Ecg ◽  
Ecg Criteria

AbstractAimsPermanent His bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing.MethodsConsecutive patients with permanent HB pacing were recruited. Surface 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss/presence of HB capture were identified. In the validation phase these criteria and the “HB ECG algorithm” were tested by two blinded observers using a separate, sizable set of ECGs.ResultsA total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. Moreover, the proposed criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in leads I, V1, V4-V6 and the R-wave peak time in V6 ≤ 100 ms) presented 100% specificity.ConclusionA novel ECG algorithm for the diagnosis of loss of HB capture and novel criteria for definitive confirmation of HB capture were formulated and validated. Practical application of these criteria during implant and follow-up of patients with HB pacing devices is feasible.Condensed AbstractThe 2-step ECG algorithm for loss of His bundle capture based on surface ECG analysis is proposed and validated. This method correctly classified 87.1% of cases with a sensitivity and specificity of 93.2% and 83.9%, respectively.What’s NewThis is the first study that analyzes QRS characteristics during non-selective His bundle pacing in a sizable cohort of patients.Precise criteria and a novel algorithm for electrocardiographic diagnosis of loss of HB capture during presumed non-selective HB pacing were validated.QRS notch/slur in left ventricular leads was identified as a simple and reproducible feature indicating loss of HB capture or lack/loss of correction of intraventricular conduction disturbances.Assessment of R-wave peak time in lead V6 rather than QRS duration for diagnosis of ns-HB pacing was validated.

scholarly journals Prognostic Implications of ‘Paced’ and ‘Native’ QRS Durations Following Cardiac Resynchronization Therapy

2016 ◽  
Vol 02 (01) ◽  
pp. 30
Author(s):  
Oguz Karaca ◽  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Response To Therapy ◽  
Cardiac Resynchronization ◽  
Current Evidence ◽  
Conduction Time ◽  
Resynchronization Therapy ◽  
Intraventricular Conduction ◽  
Surface Ecg ◽  
Future Outcomes ◽  
Electrocardiographic Parameters

Current evidence strongly suggests that the extent of electrical dyssynchrony within the left ventricle is determined by the delayed intraventricular conduction time reflected by a prolonged QRS duration (QRSd) on the surface (ECG). However, in cardiac resynchronization therapy (CRT) follow-up algorithms, the QRSd on the post-operative ECG has been relatively less frequently addressed, although the baseline QRSd is accepted as an essential ‘pre-operative’ marker for patient selection and prediction of response to therapy. In this review, we discuss the clinical impact of post-implantation electrocardiographic parameters, such as the ‘paced’ QRSd and ‘native’ QRSd (assessed when the device is temporarily switched off) on the efficacy of therapy and on prediction of future outcomes after CRT.

A Study on Intraventricular Conduction Disturbances in Electrocardiogram

1973 ◽  
Vol 3 (2) ◽  
pp. 1
Author(s):  
Woong-Ku Lee ◽  
Won Heum Shim ◽  
Hong Do Cha
Keyword(s):  
Intraventricular Conduction ◽  
Conduction Disturbances

scholarly journals Study of the time-relationship of the mechano-electrical interaction in an animal model of tetralogy of Fallot: implications for the risk assessment of ventricular arrhythmias

2020 ◽  
Vol 31 (1) ◽  
pp. 129-137
Author(s):  
Thierry Bove ◽  
Rahi Alipour Symakani ◽  
Jonas Verbeke ◽  
Anne Vral ◽  
Milad El Haddad ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Ventricular Arrhythmias ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Monophasic Action Potential ◽  
Control Group ◽  
Stroke Work ◽  
Long Term Outcome ◽  
Intraventricular Conduction ◽  
Qrs Prolongation

Abstract OBJECTIVES The long-term outcome of tetralogy of Fallot (TOF) is determined by progressive right ventricular (RV) dysfunction through pulmonary regurgitation (PR) and the risk of malignant arrhythmia. Although mechano-electrical coupling in TOF is well-known, its time effect on the inducibility of arrhythmia remains ill-defined. The goal of this study was to investigate the mechano-electrical properties at different times in animals with chronic PR. METHODS PR was induced by a transannular patch with limited RV scarring in infant pigs. Haemodynamic assessment included biventricular pressure–volume loops after 3 (n = 8) and 6 months (n = 7) compared to controls (n = 5). The electrophysiological study included endocardial monophasic action potential registration, intraventricular conduction velocity and induction of ventricular arrhythmia by burst pacing. RESULTS Progressive RV dilation was achieved at 6 months (RV end-diastolic volume 143 ± 13 ml/m2—RV end-systolic volume 96 ± 7 ml/m2; P < 0.001), in association with depressed RV contractility (preload recruitable stroke work-slope: 19 ± 1 and 11 ± 3 Mw.ml−1.s−1 for control and 6 m; P < 0.001) and left ventricular contractility (preload recruitable stroke work-slope: 60 ± 13 and 40 ± 11 Mw.ml−1.s−1 for control and 6 m; P = 0.005). Concomitant to QRS prolongation, monophasic action potential90-duration and dispersion at the RV and left ventricle were increased at 6 months. Intraventricular conduction was delayed only in the RV at 6 months (1.8 ± 0.2 and 2.4 ± 0.6 m/s for group 6M and the control group; P = 0.035). Sustained ventricular arrhythmias were not inducible. CONCLUSIONS In animals yielding the sequelae of a contemporary operation for TOF, mechano-electrical alterations are progressive and affect predominantly the RV after midterm exposure of PR. Because ventricular arrhythmias were not inducible despite significant RV dilation, the data suggest that the haemodynamic RV deterioration effectively precedes the risk of inducing sustained arrhythmia after TOF repair and opens a window for renewed stratification of contemporary risk factors of ventricular arrhythmias in patients operated on with currently used pulmonary valve- and RV-related techniques.

scholarly journals Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1244-1251 ◽  
Author(s):  
Nynke H M Kooistra ◽  
Martijn S van Mourik ◽  
Ramón Rodríguez-Olivares ◽  
Alexander H Maass ◽  
Vincent J Nijenhuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Pacemaker Implantation ◽  
Early Discharge ◽  
Permanent Pacemaker ◽  
Conduction Delay ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Timing Of Onset

BackgroundThe timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.Methods and resultsWe performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.ConclusionsSafe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.

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