Ventricular activation pattern assessment during right ventricular
pacing; ultra-high-frequency ECG study
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. Conclusions:
UHF-ECG ventricular dyssynchrony parameters show that cSp offers the
best ventricular synchrony followed by RVIT pacing, which should be
preferred over RVOT and other RV myocardial pacing locations.