Clinical InvestigationNative and Paced QRS Duration in Right Ventricular Apex Paced Patients
Section snippets
Patients Selection
Consecutive patients referred to our department for routine pacemaker interrogation from November 2007 to May 2009 were enrolled in study. The inclusion criteria were as follows: the ventricular pacemaker lead should be placed at the RVA; paced QRS complex could be seen in each lead in standard electrocardiography (ECG) for correct pQRSd measurement; patients with VVI(R) pacemakers or patients implanted with DDD(R) pacemakers having high or third-degree atrioventricular block; in patients with
Patients' Characteristics
From 1124 patients referred to our department for routine pacemaker interrogation, 310 patients who met the inclusion criteria were enrolled in this study. The patients' characteristics were given in Table 1. On the aspect of native QRS complex, 136 patients had NIVCB, 86 had CRBB, 45 had CLBB, 13 had incomplete right bundle-branch block, 8 had incomplete left bundle-branch block, and 21 had unclassified intraventricular conduction block. The nQRSd, pQRSd, LV diameters, and LVEF in NIVCB, CRBB,
Discussion
Our study confirmed that pQRSd and nQRSd were correlated with LV structures and function in RVA-paced patients and found that pQRSd was superior to nQRSd in terms of reflecting LV structures and function, particularly in NIVCB and CRBB patients. These results can be explained by the difference between pQRSd caused by RVA pacing and nQRSd activated by normal sinus rhythm. During normal sinus rhythm, the electrical activation conducts through the His Purkinje System (HPS) and then ventricular
Conclusion
In RVA paced patients, both pQRSd and nQRSd are correlated with LV structures and function, but pQRSd is superior to nQRSd in terms of reflecting LV structures and function. nQRSd is positively correlated with pQRSd in NIVCB or CRBBB or CLBBB patients. However, BBB has no significant effect on pQRSd after adjustment for LVEF and LV dimensions. Further studies are needed to clarify whether BBB is an independent risk factor for the development of HF after RVA pacing.
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Cited by (6)
Prolonged Ventricular Conduction and Repolarization During Right Ventricular Stimulation Predicts Ventricular Arrhythmias and Death in Patients With Cardiomyopathy
2017, JACC: Clinical ElectrophysiologyCitation Excerpt :RV-paced QRS duration has been associated with the degree of myocardial disease. Sumiyoshi et al. (21) evaluated paced QRS duration in patients with pacemakers and found that a paced QRS duration >180 ms was associated with decreased LV function compared with patients with a paced QRS duration ≤180 ms. Similarly, other investigators reported that in patients with implantable devices, longer paced QRS duration is associated with more severe cardiac dysfunction and is a better marker of subjacent cardiomyopathy than is baseline QRS duration (22). In addition, patients with cardiomyopathy, heart block, and a paced QRS duration >190 ms were more likely to have clinical heart failure events than those with a shorter paced QRS duration (23), and a prolonged paced QRS duration at pacemaker implantation was associated with a higher incidence of heart failure hospitalization (24).
Pacing-Induced Cardiomyopathy: “It's Tough to Make Predictions, Especially About the Future”**
2016, Journal of Cardiovascular ElectrophysiologyThe role of biventricular pacing in the prevention and therapy of pacemaker-induced cardiomyopathy
2015, Annals of Noninvasive ElectrocardiologyFragmentation of the paced QRS complex: A marker of antitachycardia pacing effectiveness among ICD patients
2014, Journal of Cardiovascular ElectrophysiologyDoes paced QRS duration predict the risk of heart failure events during permanent right ventricular pacing?
2013, European Journal of Heart Failure
The authors have no conflicts to disclose.
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Drs Wenzhi Pan and Yangang Su contributed equally to this work.