Influence of the right ventricular septum/free-wall boundary (hinge) on differentiation of the ventricular lead implantation site. Issue 4 (October 2022)

• Record Type: Journal Article
• Authors: Tsukahara, Keita; Oginosawa, Yasushi; Fujino, Yoshihisa; Keishiro, Yagyu; Miyamoto, Taro; Yamagishi, Yasunobu; Ohe, Hisaharu; Kohno, Ritsuko; Kataoka, Masaharu; Abe, Haruhiko
• Is Part Of: Journal of cardiology. Volume 80:Issue 4(2022)
• Page Start: 332
• Page End: 338
• Publication Date: 2022-10
• Subjects: Computed tomography -- Electrocardiogram -- Pacemaker -- Right ventricular lead -- Septal pacing; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2022.05.005
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: 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). Methods: 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 aVL and precordial leads V5 and V6 ) previously reported to be useful in differentiating pacing sites. Results: 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. Conclusions: 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. Graphical abstract: Location of RV lead tip confirmed by CT and each ECG algorithm. Unlabelled Image Highlights: We quantitatively examined the diagnostic capabilities of electrocardiograpy (ECG) and pacing sites. Paced QRS duration correlated with the distance from the hinge to the lead tip. Estimation of the lead tip implantation site using the ECG algorithm was useful. The accuracy of the algorithm decreased around the hinge.