Address for correspondence:
Karol Curila, MD, PhD., MSc
Cardiocenter, Third Faculty of
Medicine, Charles University, Srobarova 50, 100 34 Prague, Czech
Republic, Phone: + 420 267 162 621
Email: karol.curila@fnkv.cz, ORCID identifier: 0000-0003-3523-6358
Disclosures: participating research institutions filed European
patent application EP 19212534.2: “Method of electrocardiographic
signal processing and apparatus for performing the method.”
Funding sources: This paper was supported by the Charles
University Research Program Q38, Research Centre program No.
UNCE/MED/002, 260530/SVV/2020 and by the CAS project RVO:68081731, and
by Ministry of Education, Youth, and Sports of the Czech Republic,
project LQ1605
Abstract
Background : Right ventricular (RV) pacing causes delayed
activation of remote ventricular segments. We used the UHF-ECG to
describe ventricular depolarization when pacing different RV locations.
Methods : In 51 consecutive patients, temporary pacing was
performed at the RV apex, anterior and lateral wall, and at the RV
septum with (cSp) and without direct conductive tissue engagement (mSp)
(further subclassified as RVIT and RVOT for septal inflow and outflow
positions). The timing of UHF-ECG electrical activations were quantified
as: left ventricular lateral wall delay (LVLWd; V8 activation delay), RV
lateral wall delay (RVLWd; V1 activation delay), and LV lateral wall
depolarization duration (V5-8d).
Results: The LVLWd was shortest for cSp (11 ms (95% CI; 5;17),
followed by the RVIT (19 ms (11;26) and the RVOT (33 ms (27;40),
(p<0.01 between all of them), although the QRSd for the latter
two were the same (153 ms (148;158) vs. 153 ms (148; 158); p=0.99). The
RVOT caused longer V5-8d (9 ms (3;14) compared to the RVIT (1 ms (−5;8),
p<0.05. RV apical capture not only had a worse LVLWd (34 ms
(26;43) compared to mSp (27 ms (20;34), p<0.05), but its RVLWd
(17 ms (9;25) was also the longest compared to other RV pacing sites
(mean values for cSp, mSp, anterior and lateral wall captures being
below 6 ms), p<0.001 compared to each of them.