The Relationship between Right Ventricular Lead Position and Paced QRS Duration

2012 ◽  
Vol 36 (2) ◽  
pp. 187-193 ◽  
Author(s):  
TOHRU KAWAKAMI ◽  
NOBUKIYO TANAKA ◽  
HIROYOSHI OHNO ◽  
HIROKO KOBAYAKAWA ◽  
TOMOHIRO SAKURAI ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Lead Position ◽  
Ventricular Lead ◽  
Qrs Duration ◽  
The Relationship

Can Right Ventricular Lead Position Influence Paced QRS Duration in Patients with Abnormal and Normal Left Ventricular Function?

2017 ◽  
Author(s):  
Melissa Moey
Keyword(s):  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valuable Insight ◽  
Ventricular Ejection Fraction ◽  
Lead Position ◽  
Lead Placement ◽  
Ventricular Lead ◽  
Qrs Duration

Right ventricular apical pacing (RVAP) in pacemaker or implantable cardioverter‐defibrillator (ICD) therapy has been associated with the development and exacerbation of heart failure (HF). Studies have suggested that RVAP resulting in dyssynchronous left ventricular (LV) activation and prolonged QRS duration leads to progressive mechanical dysfunction, decreased systolic function and increased mortality. These data suggest that the effect may be most pronounced in patients with pre‐existing LV systolic dysfunction. Pacing at the RV septum however has demonstrated narrower paced QRS durations and is being considered as an alternative pacing site to the RVA. In this study, the effect of RV lead placement on the QRS duration in patients with LV systolic dysfunction who demonstrate a left ventricular ejection fraction (LVEF) < 35% and normal LVEF was compared.  Patients of a minimum age of 18 years with LVEF ≥ 50% (normal cohort) and LVEF ≤ 30% (HF cohort) were recruited. Four 3 minute high resolution recordings were obtained from an orthogonal lead position for subsequent offline signal averaging. Recordings of native rhythm and pacing at three RV sites: right ventricular outflow tract (RVOT), mid‐septum and RV apex (RVA) were obtained. A 12‐lead electrocardiogram (ECG) recording at each pacing site was stored for later confirmation of pacing location and comparison with paced averaged QRS duration. The QRS duration at different RV sites in the two populations was then compared.  As studies to date are limited, this study provided valuable insight on RV lead placement on QRS duration in device therapy for HF treatment.  

scholarly journals Optimization of right ventricular lead position in cardiac resynchronisation therapy☆

2006 ◽  
Vol 8 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Lucie Riedlbauchová ◽  
Robert Ĉihaák ◽  
Jan Byteŝník ◽  
Vlastimil Vanĉura ◽  
Petr Frídl ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Cardiac Resynchronisation Therapy ◽  
Lead Position ◽  
Ventricular Lead ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients-A Subanalysis of the Multicenter Randomized SPICE Trial

2016 ◽  
Vol 39 (3) ◽  
pp. 261-267 ◽  
Author(s):  
STEFAN ASBACH ◽  
CARSTEN LENNERZ ◽  
VERENA SEMMLER ◽  
CHRISTIAN GREBMER ◽  
ULRICH SOLZBACH ◽  
...  
Keyword(s):  
Right Ventricular ◽  
End Points ◽  
Lead Position ◽  
Ventricular Lead ◽  
The Right

scholarly journals Left bundle branch pacing: efficacy and safety compared to right ventricular outflow tract pacing

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Riano Ondiviela ◽  
M Cabrera Ramos ◽  
JR Ruiz Arroyo ◽  
J Ramos Maqueda
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Pacing Threshold ◽  
Ventricular Ejection Fraction ◽  
Ventricular Lead ◽  
Qrs Duration

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing-induced cardiomyopathy and adverse clinical outcomes. Left bundle branch pacing (LBBP) has recently emerged as a mode of conduction system pacing in the quest for physiological pacing. Purpose The aim of our study was to assess LBBP feasibility and safety compared to right ventricular outflow tract pacing (RVOTP). Methods Single centre randomized clinical trial to investigate acute success, feasibility and safety of LBBP versus RVOTP. May to October 2020. Patients with pacemaker indication and preserved LVEF were randomized 1:1 and followed up 3 months. Success was defined in LBBP group as a paced ECG &lt; 120ms or with a 20% length reduction from the basal ECG. Results 120 patients were randomized, 60 in each group, 61% males. The mean age was 77,9 ± 9 years and third-degree AVB was the main pacing indication. The procedure was successful in 95% of the cases in both groups (p = 1). The paced QRS interval was narrower in the LBBP group compared to the RVOT group (99 ± 2 ms vs 113,6 ± 11,7 ms, p &lt; 0,001). Lower fluoroscopy times were achieved in LBBP group (3.1 ± 2.1 min vs 4.3 ± 3.4, p = 0,035) and also longer procedure times in LBBP group (68,9 ± 36,9 min vs 44,3 ± 18,7 min, p &lt; 0,001). No complications were achieved and no difference in ventricular lead dislocation was found between both groups (1.6% vs 1.6%)(p = 1). Conclusions LBBP is feasible, safe and provides a narrower paced QRS compared to RVOTP. LBBP required lower fluoroscopy times but longer procedure times compared to RVOTP. LBBP (n = 60) RVOTP (n = 60) p Age (mean ± SD) 76,7 ± 9 79,7 ± 8 0,067 Male gender 62 (37) 60 (36) 1 Successful procedure 95 (57) 95 (57) 1 Basal left bundle branch block 15 (9) 13 (8) Basal QRS duration (mean ± SD) 112,6 ± 29,6 109,9 ± 25,8 0,59 Pacing QRS duration (min)(mean ± SD) 99 ± 2 139,6 ± 11,7 &lt; 0,001 Procedure time (min) (mean ± SD) 68,9 ± 36,9 44,3 ± 18,7 &lt; 0,001 Fuoroscopy time (min)(mean ± SD) 3.1 ± 2.1 4.3 ± 3.4 0,035 R wave (mV)(mean ± SD) 9,9 ± 5,7 9,9 ± 5 0,98 Right ventricle pacing threshold (V)(mean ± SD) 0,67 ± 0,3 0,58 ± 0,24 0,08 Ventricular lead dislocation 1.6 (1) 1.6 (1) 1

Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D

Heart Rhythm ◽  
2013 ◽  
Vol 10 (12) ◽  
pp. 1770-1777 ◽  
Author(s):  
Valentina Kutyifa ◽  
Poul Erik Bloch Thomsen ◽  
David T. Huang ◽  
Spencer Rosero ◽  
Christine Tompkins ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Right Ventricular ◽  
Ventricular Tachyarrhythmias ◽  
Lead Position ◽  
Ventricular Lead ◽  
The Right

139 How important is the right ventricular lead position in patients undergoing cardiac resynchronisation therapy?

Heart ◽  
2010 ◽  
Vol 96 (Suppl 1) ◽  
pp. A80.2-A80
Author(s):  
F Z Khan ◽  
P Salahshouri ◽  
M S Virdee ◽  
P A Read ◽  
M Elsik ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Cardiac Resynchronisation Therapy ◽  
Lead Position ◽  
Ventricular Lead ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
The Right

scholarly journals Can atrioventricular node ablation be safely performed in patients with permanent His bundle pacing? Data from a multicentric registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Chaumont ◽  
N Auquier ◽  
A Mirolo ◽  
E Popescu ◽  
A Milhem ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Rate Control ◽  
Atrioventricular Node ◽  
Atrial Arrhythmia ◽  
Av Node ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Ventricular Lead ◽  
Qrs Duration

Abstract Introduction Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of HBP but there is still very limited data about the feasibility of AVNA after HBP. Purpose To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia. Methods We included in three hospitals between september 2017 and december 2019 all patients who underwent AVNA for non-controlled atrial arrhythmia after permanent His bundle pacing. No back-up right ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheter. Acute HBP threshold increase during AVNA was defined as a threshold elevation &gt;1V. His bundle capture (HBC) thresholds were recorded at 3 months follow-up. Results AVNA after HBP lead implantation was performed in 45 patients. HBP and AVNA were performed simultaneously during the same procedure in 10. AVNA was successful in 32 of 45 patients (71%). Modulation of the AV node conduction was obtained in 7 patients (16%). The mean procedure duration was 42±24min, and mean fluoroscopy duration was 6.4±8min. A mean number of 7.7±9.9 RF applications (347±483 sec) were delivered to obtain complete / incomplete AV block. Acute HBC threshold increase occurred in 8 patients (18%) with return to baseline value at day 1 in 5 patients. There was no lead dislodgment during the AVNA procedures. Mean HBC threshold at implant was 1.26±[email protected] and slightly increased at 3 months follow-up (1.34±[email protected]). AV node re-conduction was observed in 5 patients (16% of the successful procedures) with a second successful ablation procedure in 4 patients. No ventricular lead revision was required during the follow-up period. The baseline native QRS duration was 102±21 ms and the paced QRS duration was 107±18 ms. Conclusion AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBC but seems technically difficult with significant AV nodal re-conduction rate. The presence of a back-up right ventricular lead could have changed our results and therefore would require further evaluation. Unipolar HBP after AV node ablation Funding Acknowledgement Type of funding source: None

To the Editor: Optimizing right ventricular lead position for defibrillation

Heart Rhythm ◽  
2012 ◽  
Vol 9 (12) ◽  
pp. e26-e27
Author(s):  
Carl R. Reynolds ◽  
Michael R. Gold
Keyword(s):  
Right Ventricular ◽  
Lead Position ◽  
Ventricular Lead

scholarly journals Association between right ventricular lead position and clinical outcomes in patients with cardiac resynchronization therapy

EP Europace ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 629-635 ◽  
Author(s):  
Mads Brix Kronborg ◽  
Jens Brock Johansen ◽  
Sam Riahi ◽  
Helen Hoegh Petersen ◽  
Jens Haarbo ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Clinical Outcomes ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Lead Position ◽  
Ventricular Lead
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