Marcadores electrocardiográficos de estimulación septal del tracto de salida del ventrículo derecho
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Introducción: Los patrones electrocardiográficos de verdadera estimulación septal del tracto de salida del ventrículo derecho no están claramente identificados.
Objetivo: Identificar los marcadores electrocardiográficos de estimulación septal del tracto de salida del ventrículo derecho.
Métodos: Se realiza un estudio observacional en 30 pacientes con implante del electrodo ventricular permanente en el tracto de salida del ventrículo derecho. Para el electrocardiograma de 12 derivaciones se programó la estimulación en modo VVI a 100 latidos por minuto. La posición del electrodo se validó con la ecocardiografía transtorácica bidimensional.
Resultados: Los verdaderos implantes septales fueron 21/30 (80 %). La media de la duración del QRS fue menor en el grupo septal (126,2 ± 9,7 ms vs. 144,4 ± 15,1 ms; p = 0,003) y la melladura del QRS en DII, DIII, aVL y aVF se relacionó con la ubicación no septal: p = 0,005, p = 0,019, p = 0,049 y p = 0,005, respectivamente. El QRS neto en DII (14,3 ± 6,0 mm vs. 9,3 ± 3,0 mm; p = 0,045), DIII (12,6 ± 5,8 mm vs. 8,0 ± 4,7 mm; p = 0,036) y aVF (14,0 ± 6,4 mm vs. 8,8 ± 4,3 mm; p = 0,025) fue mayor en el grupo septal. La duración del QRS estimulado ≤ 135 ms mostró sensibilidad en el 81,0 % y especificidad en el 66,7 % y la ausencia de melladura en las derivaciones inferiores, sensibilidad 95,2 % y especificidad 44,4 % para identificar estimulación septal.
Conclusiones: Los marcadores electrocardiográficos de estimulación septal del tracto de salida de ventrículo derecho son heterogéneos; los indicadores de validez, de la duración del QRS y la ausencia de melladura en derivaciones inferiores son adecuados para identificar este sitio de estimulación.
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