Electrocardiographic markers for septal stimulation of the right ventricular outflow tract
Keywords:
cardiac pacing artificial, ventricular septum, electrocardiogram.Abstract
Introduction: Electrocardiographic patterns of true septal stimulation of the right ventricular outflow tract are not clearly identified.
Objective: To identify electrocardiographic markers of septal stimulation of the right ventricular outflow tract.
Methods: Observational study in 30 patients with permanent ventricular electrode implantation in the right ventricular outflow tract. For the 12-lead electrocardiogram, stimulation was programmed in VVI mode at 100 beats per minute. The position of the electrode was validated with two-dimensional transthoracic echocardiography.
Results: 21/30 (80%) were true septal implants. The mean QRS duration was shorter in the septal group (126.2 ± 9.7 ms vs. 144.4 ± 15.1 ms; p = 0.003) and the QRS notching in DII, DIII, aVL and aVF was related to non-septal location; p = 0.005, p = 0.019, p = 0.049 and p = 0.005, respectively. The net QRS in 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) and aVF (14.0 ± 6.4 mm vs. 8.8 ± 4.3 mm; p = 0.025) was higher in the septal group. The duration of the stimulated QRS ≤ 135 ms showed a sensitivity of 81.0 % and a specificity of 66.7% and the absence of notching in inferior leads, a sensitivity of 95.2% and a specificity of 44.4% to identify septal stimulation.
Conclusions: Electrocardiographic markers of septal stimulation of the right ventricular outflow tract are heterogeneous; validity indicators, QRS duration ≤ 135 ms and the absence of notching in inferior leads, may be adequate indicators of right ventricular outflow septal stimulation.Downloads
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