Am J Cardiovasc Dis 2013;3(4):264-272

Original Article
How can we identify the optimal pacing site in the right ventricular septum?
A simplified method applicable during the standard implanting procedure

Gianni Pastore, Francesco Zanon, Enrico Baracca, Gianluca Rigatelli, Giorgio Corbucci, Alberto Mazza, Franco Noventa,
Loris Roncon

Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Formerly Medtronic Bakken Research Center, Maastricht
(NL); Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy; Departments of Clinical and Experimental
Medicine, University of Padova School of Medicine, Padova, Italy

Received August 23, 2013; Accepted September 2, 2013; Epub November 1, 2013; Published November 15, 2013

Abstract: Aims: A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing site.
Although this could be achieved by continual 12-Lead ECG monitoring, such a technique is not applicable during
pacemaker (PM) implantation. The purpose of this study was to validate a method for identifying the optimal site for RV
septum pacing using simple markers derived from few real-time ECG leads and fluoroscopy (F). Methods and results: An
overall of 304 measurements of pQRSd in different RV sites was performed in 102 patients undergoing PM implant. In
accordance with F position the lead placement was classified high, medium, and low septum. Paced
electrocardiographic/fluoroscopic parameters (q-wave/negative QRS in lead I, notching in limb leads, R/S wave in lead II,
QRS precordial leads transition, and F septal segments pacing site) were analyzed to predict short pQRSd (≤ 160 ms).
Logistic regression analysis showed that pQRSd > 160 ms was predicted by presence of pQRS notching in limb leads
(OR = 3.24, p < 0.001), and with negative amplitude of QRS in lead II (OR = 2.53, p = 0.03). Short pQRSd (≤ 160 ms) was
observed with mid F position (OR = 0.31, p < 0.001) and with the presence of a q-wave/negative QRS in lead I. Conclusion:
In RV septum pacing, simple QRS markers of few limb leads (lead I/II) added to F position are usefull to identifying the
optimal site to place the RV lead. (AJCD1308006).

Keywords: Ventricular pacing, septal pacing, ECG

Address correspondence to: Dr. Gianni Pastore, Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140
45100 Rovigo, Italy. Fax: +39-0425-393597; E-mail:
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