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Background:
With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing.
Purpose:
This study was sought to determine di...
Context in source publication
Similar publications
Purpose
Response to cardiac resynchronization therapy (CRT) is well-established in patients with typical left bundle branch block (LBBB) but modest or even negative in those with intraventricular conduction delay (IVCD). However, IVCD pattern is heterogeneous, and it is possible that QRS patterns may also respond to CRT.
Methods
Consecutive baseli...
Background
To develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre‐ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns.
Methods
This study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre‐ET, collected from our hospital and through PubMed...
Background:
Suboptimal device programming is among the reasons for reduced response to cardiac resynchronization therapy (CRT). However, whether systematic optimization is beneficial remains unclear, particularly late after CRT implantation. The aim of this single-center cohort study was to assess the effect of systematic atrioventricular delay (A...
Background/purpose:
A deleterious effect of complete left bundle-branch block (cLBBB) on left ventricular (LV) function has been established. The underutilization of cardiac resynchronization therapy has been noted in Taiwan and the Asian-Pacific area, but the reasons remain unclear. This study aimed to evaluate the prevalence and association of c...
Background:
Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture).
Objective:
To investigate acute electrophysiological effects of LBBP and LVSP as co...
Citations
... R or r waves in V 1 were observed in 65% to 93% of patients with biventricular pacing. 526,527 CRT loss may occur during exercise in the presence of AF with high ventricular rate or due to AV interval shortening; 24hour Holter monitoring and exercise stress test may be useful to identify such cases. Increased LV capture thresholds account for 10% of cases of CRT pacing loss. ...
... Ondas r ou R em V1 estão presentes em 65% a 93% das estimulações biventriculares. 526,527 A perda da ressincronização pode ocorrer ao esforço, na presença de FA de alta resposta e devido ao encurtamento do intervalo AV; Holter-24h e teste ergométrico podem ser úteis para identificar tais cenários. Aumento do limiar de captura do VE é responsável por 10% dos casos de perda da ressincronização. ...
... interkostal aralıklardan) alınması gibi durumlarda da V1'de negatif bir QRS konfigürasyonu izlenebilmektedir. [10,14,15] Herweg ve ark., [10] V1'de negatif QRS kompleksinin varlığının SV uyarı bölgesinde uzamış latansı (≥40 ms) öngörmedeki duyarlılığını %80, özgüllüğünü ise %97 olarak belirlemişlerdir. Bunun dışında, SğV elektrodunun SğV çıkış yoluna veya interventriküler septuma yerleştirildiği biventriküler uyarı zamanı da genellikle V1'de negatif QRS kompleks olarak izlenmektedir (Şekil 3). ...
Objectives
In this cohort study, we analyzed if a specific pattern in three leads of the electrocardiogram (Rs in V1, Qr in aVL, or rS in I) was associated with outcomes after cardiac resynchronization therapy (CRT) depending on age.
Methods
Patients with CRT devices were included from January 2012 to April 2019. We divided the sample into 2 groups, those with age ≥ 75 years old and those younger. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalization at 1 year.
Results
We included 111 patients. Patients older than 75 years (26.1%, n=29) had a significantly higher rate of hypertension and atrial fibrillation and received less frequently optimal medical therapy. The patterns were observed in 32 (39.0%) younger patients and 11 (37.9%) older patients. Patients who presented any of them had a lower incidence of the primary endpoint in the younger group (0 vs. 14%, p=0.029), but not in the older group (9.1 vs. 27.8%, p=0.24). The presence of a basal QRS duration greater than 160 milliseconds was associated with a higher rate of the primary endpoint in the elderly (50 vs. 13%, p=0.015), but not in the younger group (16.7 vs. 7.1%, p=0.254).
Conclusions
The presence of the selected patterns after CRT is associated with a lower incidence of all-cause death and hospitalization for HF in patients younger than 75 years, but not in those older than 75 years. Conversely, baseline QRS duration was associated with worse outcomes in older patients, but not in the younger group.
Cardiac resynchronization therapy (CRT) has been established as an effective mode of therapy in patients with heart failure and concurrent cardiac dyssynchrony, principally in the form of left bundle branch block (LBBB). The wide-spread use of CRT has ushered in a new landscape in 12-lead electrocardiography (ECG). ECG readings in these patients are most important to guide troubleshooting and also appropriate device programming, as well as discerning and managing non-responders. A set of 4 ECG recordings need to accompany each patient with a CRT device, including a baseline ECG and recordings from monochamber (right and left ventricular) and biventricular pacing, which can be compared against a new recording to facilitate evaluation of proper vs problematic biventricular pacing. Precordial ECG leads V1/2 acquired at the 4th intercostal space and limb leads, I and III, together with a quick assessment of perpendicular leads I and aVF to determine quadrant of the QRS axis in the hexaxial diagram, may provide the framework for proper ECG interpretation in these patients. This important issue of 12-lead electrocardiography in CRT patients is herein reviewed, pitfalls are pointed out and practical tips are provided for ECG reading to help recognize and manage problems with CRT device function. Furthermore, several pertinent ECG recordings and tabulated data are provided, and an algorithm is suggested that integrates prior algorithms and relevant information from current literature.
This article is protected by copyright. All rights reserved.
Introduction:
Dyssynchrony persists in many patients despite cardiac resynchronization therapy (CRT). Aim of this proof-of-concept study was to achieve better CRT, with a QRS approximating the normal width and axis, by using His bundle pacing and non-conventional pacing configurations.
Methods and results:
In 20 patients with CRT indications, we performed an acute intra-patient comparison between conventional biventricular (CONV) and three non-conventional pacing modalities: His bundle pacing alone (HBP), His bundle and coronary sinus pacing (HBP+CS) and HBP+CS plus right ventricular pacing (TRIPLE). Electrical dyssynchrony was assessed by means of QRS width and axis; "quasi-normal" axis meant an R/S ratio ≥1 in leads I and V6 and ≤1 in V1. Mechanical dyssynchrony was assessed by speckle tracking echocardiography. QRS width was 153±18 ms on CONV, shortened to 137±16 ms on HBP+CS (p=0.001) and to 130±14 ms on TRIPLE (p=0.001), while it remained unchanged on HBP (159±32 ms, p=0.17). The rate of patients with "quasi-normal" axis was 5% on CONV, and increased to 90% on HBP (p=0.0001), to 63% on HBP+CS (p=0.001) and to 44% on TRIPLE (p=0.02). On radial strain analysis, the time-to-peak difference between antero-septal and postero-lateral segments was 143±116 ms on CONV, shortened to 121±127 ms on HBP (p=0.79), to 67±70 ms on HBP+CS (p=0.02) and to 76±55 ms on TRIPLE (p=0.05). On discharge, HBP was chosen in 15% of patients, HBP+CS in 55% and TRIPLE in 30%; CONV was never chosen.
Conclusion:
Non-conventional modalities of CRT provide acute additional electrical and mechanical resynchronization. An inter-patient variability exists. This article is protected by copyright. All rights reserved.
