Radiological and electrocardiographic characterization of right ventricular outflow tract pacing

The right ventricular outflow tract (RVOT) is used as an alternative pacing site, but its superiority to the RV apex remains to be established. This lack of proof may in part be explained by heterogeneity within the RVOT-paced group, due to poor definitions of the RVOT. The aim of the present study...

Full description

Saved in:
Bibliographic Details
Published in:Europace (London, England) England), 2010-12, Vol.12 (12), p.1739-1744
Main Authors: Balt, Jippe C, van Hemel, Norbert M, Wellens, Hein J J, de Voogt, Willem G
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cardiac Pacing, Artificial - methods
Cohort Studies
Electrocardiography
Heart Conduction System - physiopathology
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Humans
Middle Aged
Pacemaker, Artificial
Radiography
Retrospective Studies
Sensitivity and Specificity
Ventricular Septum - physiopathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The right ventricular outflow tract (RVOT) is used as an alternative pacing site, but its superiority to the RV apex remains to be established. This lack of proof may in part be explained by heterogeneity within the RVOT-paced group, due to poor definitions of the RVOT. The aim of the present study is to characterize the RVOT in terms of fluoroscopic and electrocardiographic parameters. One hundred and forty-three patients who underwent pacemaker implantation with a ventricular lead in the RVOT were included. Lead position was determined by fluoroscopy. The RVOT was divided into three areas: anterior, septal, and free wall (FW). On a 12-lead electrocardiogram (ECG) during forced ventricular pacing, QRS duration, configuration, and amplitude was determined. Lead position was judged to be anterior in 52 (36%), septal in 43 (30%), and FW in 48 (34%) patients, respectively. QRS duration is not significantly different between groups. QRS axis differs significantly between pacing sites (septal 79 ± 31°, anterior 60 ± 46°, FW 47 ± 38°, P < 0.05). QRS vector in lead I and QRS morphology and vector in lead aVL differ significantly between pacing sites. Precordial transition is earlier (towards V1) in septal pacing. This study demonstrates heterogeneity of pacing site and depolarization pattern within a cohort of patients paced form the RVOT. However, due to considerable overlap, we could not define clear cut-off point or devise flow-charts to match ECG and pacing site.
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/euq341