Summary
UHF-ECG differentiates ventricular depolarization patterns during RV
septal, apical, anterior wall, and lateral wall pacing and between
different locations on the RV septum. Of these locations, capture of the
basal interventricular septum with conductive tissue engagement proved
to offer the best depolarization pattern, with placement in the right
ventricular inflow tract being the second best. The latter position
should be considered as an alternative for ventricular pacing when
pacing the His-Purkinje conduction system is not possible or available.
Our results show that UHF-ECG provides detailed and additional
information on electrical ventricular dyssynchrony during RV pacing.
References
1. Sweeney MO, Prinzen FW: A new
paradigm for physiologic ventricular pacing. Journal of the
American College of Cardiology 2006, 47(2):282-288.
2. Kaye GC, Linker NJ, Marwick TH,
Pollock L, Graham L, Pouliot E, Poloniecki J, Gammage M, Protect-Pace
trial i: Effect of right ventricular pacing lead site on left
ventricular function in patients with high-grade atrioventricular block:
results of the Protect-Pace study. Eur Heart J 2015,
36(14):856-862.
3. Domenichini G, Sunthorn H, Fleury
E, Foulkes H, Stettler C, Burri H: Pacing of the interventricular septum
versus the right ventricular apex: a prospective, randomized study.Eur J Intern Med 2012, 23(7):621-627.
4. Abdelrahman M, Subzposh FA, Beer D,
Durr B, Naperkowski A, Sun H, Oren JW, Dandamudi G, Vijayaraman P:
Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular
Pacing. Journal of the American College of Cardiology 2018,
71(20):2319-2330.
5. Keene D, Arnold AD, Jastrzebski M,
Burri H, Zweibel S, Crespo E, Chandrasekaran B, Bassi S, Joghetaei N,
Swift M et al : His bundle pacing, learning curve, procedure
characteristics, safety, and feasibility: Insights from a large
international observational study. Journal of cardiovascular
electrophysiology 2019, 30(10):1984-1993.
6. Jurak P, Curila K, Leinveber P,
Prinzen FW, Viscor I, Plesinger F, Smisek R, Prochazkova R, Osmancik P,
Halamek J et al : Novel ultra-high-frequency electrocardiogram
tool for the description of the ventricular depolarization pattern
before and during cardiac resynchronization. Journal of
cardiovascular electrophysiology 2020, 31(1):300-307.
7. Curila K, Prochazkova R, Jurak P,
Jastrzebski M, Halamek J, Moskal P, Stros P, Vesela J, Waldauf P, Viscor
I et al : Both selective and nonselective His bundle, but not
myocardial, pacing preserve ventricular electrical synchrony assessed by
ultra-high-frequency ECG. Heart rhythm 2020, 17(4):607-614.
8. Devabhaktuni S, Mar PL, Shirazi J,
Dandamudi G: How to Perform His Bundle Pacing: Tools and Techniques.Cardiac electrophysiology clinics 2018, 10(3):495-502.
9. Schwaab B, Kindermann M, Frohlig G,
Berg M, Kusch O, Schieffer H: Septal lead implantation for the reduction
of paced QRS duration using passive-fixation leads. Pacing and
clinical electrophysiology : PACE 2001, 24(1):28-33.
10. Burri H, Park CI, Zimmermann M,
Gentil-Baron P, Stettler C, Sunthorn H, Domenichini G, Shah D: Utility
of the surface electrocardiogram for confirming right ventricular septal
pacing: validation using electroanatomical mapping. Europace :
European pacing, arrhythmias, and cardiac electrophysiology : journal of
the working groups on cardiac pacing, arrhythmias, and cardiac cellular
electrophysiology of the European Society of Cardiology 2011,
13(1):82-86.
11. Osmancik P, Stros P, Herman D,
Curila K, Petr R: The insufficiency of left anterior oblique and the
usefulness of right anterior oblique projection for correct localization
of a computed tomography-verified right ventricular lead into the
midseptum. Circulation Arrhythmia and electrophysiology 2013,
6(4):719-725.
12. Sanz J, Sanchez-Quintana D,
Bossone E, Bogaard HJ, Naeije R: Anatomy, Function, and Dysfunction of
the Right Ventricle: JACC State-of-the-Art Review. Journal of the
American College of Cardiology 2019, 73(12):1463-1482.
13. Sweeney MO, Prinzen FW:
Ventricular pump function and pacing: physiological and clinical
integration. Circulation Arrhythmia and electrophysiology 2008,
1(2):127-139.
14. Vassallo JA, Cassidy DM, Miller
JM, Buxton AE, Marchlinski FE, Josephson ME: Left ventricular
endocardial activation during right ventricular pacing: effect of
underlying heart disease. Journal of the American College of
Cardiology 1986, 7(6):1228-1233.
15. Hattori M, Naruse Y, Oginosawa Y,
Matsue Y, Hanaki Y, Kowase S, Kurosaki K, Mizukami A, Kohno R, Abe Het al : Prognostic impact of lead tip position confirmed via
computed tomography in patients with right ventricular septal pacing.Heart rhythm 2019, 16(6):921-927.
16. Varma N, Jia P, Ramanathan C,
Rudy Y: RV electrical activation in heart failure during right, left,
and biventricular pacing. JACC Cardiovascular imaging 2010,
3(6):567-575.
Table 1: Patients and procedural characteristics