Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
Open Heart. 2022 Aug;9(2). doi: 10.1136/openhrt-2022-002009.
We sought to investigate whether it is possible to obtain individualised left anterior oblique (LAO) by preprocedural electrocardiographic parameters and, if so, whether these parameters can help to improve the success rate of right ventricular (RV) lead implantation into the interventricular septum.
In this observational study, we assessed the relationship between preoperative electrocardiographic parameters and the angle of the interventricular septum obtained using thoracic CT. The participants were divided into two groups: a retrospective derivation cohort to derive the optimal formula for the individual septum axis, and a prospective internal validation cohort to which we applied the optimal formula and implanted using the new method.
In the retrospective derivation cohort (n=39), the mean angle of individualised LAO assessed by thoracic CT was 53.1°±8.9°, and the preoperative ECG QRS axis was strongly correlated with the interventricular septum axis (R=0.490). LAO projection derived from the preoperative ECG QRS axis confirmed that the RV lead was placed in the interventricular septum during the pacemaker procedure in the prospective internal validation group (n=30). The success rate for placing the RV lead into the interventricular septum was significantly improved in the internal validation cohort (93% vs 64%, p<0.05). In addition, the N-terminal pro-brain natriuretic peptide level decreased significantly after surgery in the interventricular septal indwelling group.
Individualised LAO angle derived from the preoperative ECG QRS axis is a new useful and simple method for RV lead implantation into the interventricular septum.
UMIN000045741.
我们旨在探究能否通过术前心电图参数获得个体化的左前斜（LAO）角度，以及这些参数是否有助于提高右心室（RV）导联植入间隔的成功率。
在这项观察性研究中，我们评估了术前心电图参数与通过胸部 CT 获得的室间隔角度之间的关系。参与者分为两组：回顾性推导队列用于推导个体化间隔轴的最佳公式，前瞻性内部验证队列用于应用最佳公式并采用新方法进行植入。
在回顾性推导队列（n=39）中，通过胸部 CT 评估的个体化 LAO 平均角度为 53.1°±8.9°，术前 ECG QRS 轴与室间隔轴密切相关（R=0.490）。来自术前 ECG QRS 轴的 LAO 投影证实，在前瞻性内部验证组（n=30）的起搏器程序中，RV 导联被置于间隔内。在内部验证队列中，RV 导联植入间隔的成功率显著提高（93% vs 64%，p<0.05）。此外，在间隔内留置 RV 导联的组中，N 末端脑利钠肽前体水平在手术后显著降低。
从术前 ECG QRS 轴推导的个体化 LAO 角度是一种新的、简单的 RV 导联植入间隔的有用方法。
UMIN000045741。
