The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Cardiol. 2022 Oct;80(4):332-338. doi: 10.1016/j.jjcc.2022.05.005. Epub 2022 May 27.
The prognosis associated with right ventricular (RV) free-wall pacing is worse than that of septal pacing. Identification of the pacing site using a 12‑lead electrocardiogram (ECG) is controversial and may be influenced by ECG changes within the same septal or free-wall area. The relationship between the diagnostic capabilities of ECG and pacing sites has previously been qualitatively evaluated. However, in this study, this relationship was analyzed quantitatively, and accurate evaluation of the pacing site was determined using computed tomography (CT).
Of 779 consecutive outpatients, 65 who underwent pacemaker implantation and thoracic CT were prospectively included and classified into the following groups according to the lead tip position: free-wall, septal, or septum/free-wall boundary (hinge) group. The hinge was used as an anatomical marker, and the distance from the hinge to the lead tip was measured. Under RV pacing, a 12‑lead ECG was obtained. ECG findings were evaluated using three criteria (including lead I, II, and aV and precordial leads V and V) previously reported to be useful in differentiating pacing sites.
The lead tips were anchored at the free-wall in 10 patients, the septal wall in 19 patients, and the hinge in 32 patients. Paced QRS duration correlated with the distance from the hinge to the lead tip for the free-wall and septum (r = 0.47 and - 0.68, respectively). Estimation of the lead tip implantation site using the ECG algorithm was useful; however, the algorithm's accuracy decreased around the hinge.
ECG is useful in differentiating pacing sites but is less accurate around the hinge, which may be the reason that the identification of the RV pacing site using ECG remains controversial.
右心室（RV）游离壁起搏的预后比间隔起搏差。使用 12 导联心电图（ECG）确定起搏部位存在争议，并且可能受到同一间隔或游离壁区域内 ECG 变化的影响。ECG 与起搏部位诊断能力之间的关系以前已经进行了定性评估。然而，在这项研究中，对这种关系进行了定量分析，并使用计算机断层扫描（CT）准确评估了起搏部位。
在 779 例连续门诊患者中，前瞻性纳入了 65 例接受起搏器植入和胸部 CT 的患者，并根据导联尖端位置分为以下几组：游离壁组、间隔组或间隔/游离壁交界处（铰链）组。铰链用作解剖学标志物，并测量从铰链到导联尖端的距离。在 RV 起搏下，获得 12 导联 ECG。使用先前报道有助于区分起搏部位的三个标准（包括导联 I、II 和 aV 以及胸前导联 V 和 V）评估 ECG 结果。
10 例患者的导联尖端固定在游离壁，19 例患者固定在间隔壁，32 例患者固定在铰链处。起搏 QRS 持续时间与游离壁和间隔壁从铰链到导联尖端的距离相关（r 值分别为 0.47 和-0.68）。使用 ECG 算法估计导联尖端植入部位是有用的；然而，算法的准确性在铰链周围下降。
ECG 有助于区分起搏部位，但在铰链周围准确性较低，这可能是使用 ECG 确定 RV 起搏部位仍存在争议的原因。
