Am J Cardiovasc Dis 2013;3(4):264-272
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,
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: firstname.lastname@example.org
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