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Three-Dimensional Electro-Anatomical Mapping and Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing and Right Ventricular Pacing: The EMPATHY Study. J Cardiovasc Dev Dis 2022; 9:jcdd9110377. [PMID: 36354776 PMCID: PMC9698308 DOI: 10.3390/jcdd9110377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background. His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. Furthermore, studies reporting a comprehensive assessment of the ventricular function, using myocardial work (MW) evaluation are lacking. Objectives. (1) To evaluate the systematic use of the 3D-EAM as a guide to HBP; (2) to assess the electrical and mechanical activations with high-density mapping, comparing spontaneous ventricular activation (SVA), HBP and RVP; (3) to assess the myocardial function through speckle-tracking echocardiography (STE) and MW analysis in SVA, HBP and RVP. Methods. 3D-EAM was performed in consecutive patients undergoing HBP implantation with a low use of fluoroscopy. All patients were systematically evaluated with high-density mapping, MW and STE. Results. Fifteen patients were enrolled, of whom three had an implant failure (20%). RV activation time was not statistically different between SVA and HBP (103 vs. 104 ms, p = 0.969) but was significantly higher in RVP (133 ms, p = 0.011 vs. SVA and p = 0.001 vs HBP). Global constructive work was significantly lower during RVP (1191 mmHg%) than during SVA and HBP (1648 and 1505 mmHg%, p = 0.011 and p = 0.008, respectively) and did not differ between SVA and HBP (p = 0.075). Conclusions. 3D-EAM and MW evaluation showed that HBP was comparable to the physiological SVA in terms of activation time and cardiac performance. Compared to both SVA and HBP, RVP was associated with a worse activation timing and ventricular efficiency.
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Curila K, Prochazkova R, Jurak P, Jastrzebski M, Halamek J, Moskal P, Stros P, Vesela J, Waldauf P, Viscor I, Plesinger F, Sussenbek O, Herman D, Osmancik P, Smisek R, Leinveber P, Czarnecka D, Widimsky P. Both selective and nonselective His bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECG. Heart Rhythm 2020; 17:607-614. [DOI: 10.1016/j.hrthm.2019.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 10/25/2022]
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Sun J, Sha Y, Sun Q, Qiu Y, Shao B, Ni Y, Mei Y, Zhang C, Wang R. The long‐term therapeutic effects of His‐Purkinje system pacing on bradycardia and cardiac conduction dysfunction compared with right ventricular pacing: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:1202-1210. [PMID: 32162743 DOI: 10.1111/jce.14445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jin‐Yu Sun
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Ye‐Qin Sha
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Qing‐Yang Sun
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Yue Qiu
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Bo Shao
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Yi‐Hong Ni
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Yu‐Kun Mei
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
| | - Chang‐Ying Zhang
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
| | - Ru‐Xing Wang
- Department of CardiologyWuxi People's Hospital Affiliated to Nanjing Medical University Wuxi China
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Ventricular septal pacing: Optimum method to position the lead. Indian Heart J 2018; 70:713-720. [PMID: 30392512 PMCID: PMC6204444 DOI: 10.1016/j.ihj.2018.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/18/2017] [Accepted: 01/10/2018] [Indexed: 12/02/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is known for years. Several studies have revealed that adverse outcomes of RV apical pacing are directly linked to cumulative percentage of ventricular pacing. Algorithms to minimize ventricular pacing are only effective if there is good atrioventricular (AV) conduction. A need for an alternate site for ventricular pacing is evident in patients with high presumed ventricular pacing burden. Most studied alternate site for ventricular pacing is ventricular septum (outflow tract septum and mid-septum). Conventionally septal position of the ventricular pacing lead is confirmed by fluoroscopic appearance of the lead and characteristics electrocardiographic (ECG) features. However, several recent studies have challenged these fluoroscopic and ECG features as to be inadequate. So, there is need for a systematic approach for septal positioning of the ventricular lead.
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Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, Krishnan K, Crossley G, Bova Campbell K, Lee BK, Refaat MM, Saksena S, Fisher JD, Lakkireddy D. His Bundle Pacing. J Am Coll Cardiol 2018; 72:927-947. [DOI: 10.1016/j.jacc.2018.06.017] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/31/2023]
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Zanon F, Ellenbogen KA, Dandamudi G, Sharma PS, Huang W, Lustgarten DL, Tung R, Tada H, Koneru JN, Bergemann T, Fagan DH, Hudnall JH, Vijayaraman P. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace 2018; 20:1819-1826. [DOI: 10.1093/europace/euy058] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, 140, Viale Tre Martiri, Rovigo, Italy
| | | | - Gopi Dandamudi
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Daniel L Lustgarten
- Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Roderick Tung
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Jayanthi N Koneru
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
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Xing F, Jiang J, Hu X, Feng C, He J, Dong Y, Ma Y, Tang A. Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation: A retrospective observational cohort study. Medicine (Baltimore) 2018; 97:e9839. [PMID: 29419690 PMCID: PMC5944699 DOI: 10.1097/md.0000000000009839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/07/2017] [Accepted: 01/19/2018] [Indexed: 01/23/2023] Open
Abstract
Right ventricular pacing often results in prolonged QRS duration (QRSd) as the result of right ventricular stimulation, and atrial fibrillation (AF) may result. The association of pacing-induced prolonged QRSd and AF in patients with permanent pacemakers is unknown.We selected 180 consecutive patients who underwent pacemaker implantation for complete/advanced atrioventricular block. All of the patients were paced from the right ventricular septum. Electrocardiography recordings were obtained at the beginning and the end of pacemaker implantation. QRSd was measured in all 12 leads. The QRSd variation was calculated by subtracting the preimplantation QRSd from the postimplantation QRSd.The occurrence of AF was observed in 64 (35.56%) patients (follow-up 33.62 ± 21.47 mo). No significant differences in preimplantation QRSd were observed between the AF occurrence and nonoccurrence groups. The QRSd variation in leads V4 (54.22 ± 29.03 vs 42.66 ± 33.79 ms, P = .022), and V6 (64.62 ± 23.16 vs 48.45 ± 34.40 ms, P = .001) differed significantly between the occurrence and nonoccurrence groups. More QRSd variation in lead V6 (P = .005, HR = 1.822, 95% CI 1.174-2.718, interval scale of QRSd was 40 ms) and left atrial diameter (P = .045, HR = 1.042, 95% CI 1.001-1.086) were independent risk factors for AF occurrence. Receiver operating characteristic curve suggested that QRSd variation in lead V6 could predict AF occurrence, especially for patients with long preimplantation QRSd (≥120 ms, area under the curve was 0.826, 95% CI 0.685-0.967).QRSd variation in lead V6 might be positively correlated with postimplantation AF occurrence. In patients with pacemaker implantation, QRSd could be a complementary criterion for optimizing the right ventricular septal pacing site, and smallest QRSd might be worth pursuing.
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Affiliation(s)
- FuWei Xing
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - JingZhou Jiang
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - XiaoLiang Hu
- Department of Cardiology, The Third Affiliated Hospital of
Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chong Feng
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - JianGui He
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - YuGang Dong
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - YueDong Ma
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - AnLi Tang
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
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Hayashi K, Kohno R, Fujino Y, Takahashi M, Oginosawa Y, Ohe H, Miyamoto T, Fukuda S, Araki M, Sonoda S, Otsuji Y, Abe H. Pacing From the Right Ventricular Septum and Development of New Atrial Fibrillation in Paced Patients With Atrioventricular Block and Preserved Left Ventricular Function. Circ J 2016; 80:2302-2309. [DOI: 10.1253/circj.cj-16-0640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Katsuhide Hayashi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health
| | - Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health
| | - Masao Takahashi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Hisaharu Ohe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Tetsu Miyamoto
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Shota Fukuda
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Masaru Araki
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Shinjo Sonoda
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health
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Pastore G, Zanon F, Baracca E, Aggio S, Corbucci G, Boaretto G, Roncon L, Noventa F, Barold SS. The risk of atrial fibrillation during right ventricular pacing. Europace 2015; 18:353-8. [DOI: 10.1093/europace/euv268] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 12/18/2022] Open
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Pastore G, Aggio S, Baracca E, Fraccaro C, Picariello C, Roncon L, Corbucci G, Noventa F, Zanon F. Hisian area and right ventricular apical pacing differently affect left atrial function: an intra-patients evaluation. Europace 2014; 16:1033-9. [PMID: 24473501 DOI: 10.1093/europace/eut436] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA. METHODS AND RESULTS Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E'), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P < 0.001) and intra-LV dyssynchrony (P < 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P < 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E' (P = 0.049), and lower PASP (P < 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P < 0.001) and total emptying fraction (P = 0.005). CONCLUSION Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.
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Affiliation(s)
- Gianni Pastore
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Silvio Aggio
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Enrico Baracca
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Chiara Fraccaro
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Claudio Picariello
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Giorgio Corbucci
- Formerly Medtronic Bakken Research Center, 6229 Maastricht, The Netherlands
| | - Franco Noventa
- Departments of Clinical and Experimental Medicine, University of Padova School of Medicine, 35100 Padova, Italy
| | - Francesco Zanon
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
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Pang BJ, Joshi SB, Lui EH, Tacey MA, Ling LH, Alison J, Seneviratne SK, Cameron JD, Mond HG. Validation of conventional fluoroscopic and ECG criteria for right ventricular pacemaker lead position using cardiac computed tomography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:495-504. [PMID: 24215477 DOI: 10.1111/pace.12301] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/27/2013] [Accepted: 09/23/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION It is hypothesized that pacing the right ventricular (RV) septum is associated with less deleterious outcomes than RV apical pacing. Our aim was to validate fluoroscopic and electrocardiography (ECG) criteria for describing pacemaker and implantable cardioverter defibrillator RV "septal" lead position against the proposed gold standard: cardiac computed tomography (CT). METHODS Using the conventional fluoroscopic criteria, we intended to place RV nonapical leads on the interventricular septum. Lead positions were later retrospectively analyzed with CT and correlated with ECGs and fluoroscopic projections: posterior-anterior, 40° left anterior oblique (LAO), 40° right anterior oblique (RAO), and left lateral. RESULTS Only 21% (nine of 35) of presumed "septal" RV nonapical leads using the conventional fluoroscopic criteria were on the true septum. A schema developed to define septal position in the RAO fluoroscopic view had high agreement with CT images. ECG criteria had only fair to moderate agreement with CT. The paced QRS duration was significantly longer (P < 0.001) with RV apical pacing (176 ± 10.7 ms), compared to RV nonapical pacing (144.5 ± 14.3 ms). CONCLUSION Using the conventional fluoroscopic criteria, only a minority of RV leads were implanted on the true RV septum. Instead, aiming for the middle of the cardiac silhouette in the RAO fluoroscopic view, confirming rightward orientation in the LAO view, and having a paced QRS duration <140 ms may allow the implanting cardiologist a simple, more accurate method to achieve true RV septal lead positioning.
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Affiliation(s)
- Benjamin J Pang
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; The Department of Medicine, University of Melbourne, Victoria, Australia
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Kumar P, Upadhyay GA, Cavaliere-Ogus C, Heist EK, Altman RK, Chatterjee NA, Parks KA, Singh JP. Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: a pilot study. J Interv Card Electrophysiol 2012; 36:223-31. [DOI: 10.1007/s10840-012-9759-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022]
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Pastore G, Aggio S, Baracca E, Rigatelli G, Zanon F, Roncon L, Noventa F, Barold SS. A new integrated approach to improve left ventricular electromechanical activation during right ventricular septal pacing. Europace 2011; 14:92-8. [PMID: 21868411 DOI: 10.1093/europace/eur270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The deleterious effects of apical right ventricular pacing has fostered the utilization of alternative pacing sites. Although right ventricular septal (RVS) sites are commonly used, the results have been controversial because of poor standardization of lead position by fluoroscopy. This study investigated the utility of a new RVS pacing technique based on the combination of fluoroscopy (F), and electrophysiological mapping (F + EP). Left ventricular (LV) electromechanical activation was determined in patients undergoing RVS pacing and the results of the F + EP approach were compared with those derived from standard F alone. METHODS AND RESULTS Between December 2008 and November 2010 we enrolled 156 consecutive patients undergoing permanent RVS pacing. The standard F approach was used in 93 patients and the F + EP technique was applied to 63 patients. Electromechanical activation was assessed by: (i) electromechanical latency (EML) interval measured from the QRS onset to the mechanical activation of the basal LV and (ii) intra-LV dyssynchrony measured as the interval from the earliest to the latest LV basal motion. Intra-LV dyssynchrony was found in 46.2% patients in the F group compared with 15.9% in the group F + EP (P < 0.001). The F group demonstrated a significantly higher degree of intra-LV dyssynchrony than F + EP group (43.9 ± 24.3 vs. 26.5 ± 15.4 ms; P < 0.001). The F group exhibited a significantly higher EML duration compared with the F + EP group (215.8 ± 25.3 vs. 195.1 ± 17.4 ms; P < 0.001). CONCLUSION During RVS pacing, the F + EP approach provides a more physiological LV activation than the standard F technique. The prognostic significance of these short-term findings needs to be correlated with long-term data.
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Affiliation(s)
- Gianni Pastore
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
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Hillock RJ, Mond HG. Pacing the right ventricular outflow tract septum: time to embrace the future. Europace 2011; 14:28-35. [PMID: 21846639 DOI: 10.1093/europace/eur251] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients.
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Affiliation(s)
- Richard J Hillock
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, Australia
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MOND HARRYG, VLAY STEPHENC. Pacing the Right Ventricular Septum: Time to Abandon Apical Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1293-7. [DOI: 10.1111/j.1540-8159.2010.02876.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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