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Ventricular activation pattern assessment during right ventricular pacing; ultra-high-frequency ECG study
  • +14
  • Karol Curila,
  • Pavel Jurak,
  • Josef Halamek,
  • Frits Prinzen,
  • Petr Waldauf,
  • Jakub Karch,
  • Petr Stros,
  • Filip Plesinger,
  • Jan Mizner,
  • Marketa Susankova,
  • Radka Prochazkova,
  • Ondrej Sussenbek,
  • Ivo Viscor,
  • Vlastimil Vondra,
  • Radovan Smisek,
  • Pavel Leinveber,
  • Pavel Osmancik
Karol Curila
Charles University and University Hospital Kralovske Vinohrady
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Pavel Jurak
Institute of Scientific Instruments
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Josef Halamek
Institute of Scientific Instruments Czech Academy of Sciences
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Frits Prinzen
Maastricht Univeristy
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Petr Waldauf
Charles University and University Hospital Kralovske Vinohrady
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Jakub Karch
Charles University and University Hospital Kralovske Vinohrady
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Petr Stros
Cardiocenter, Third Faculty of Medicine, Charles University
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Filip Plesinger
Institute of Scientific Instruments of the Czech Academy of Sciences
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Jan Mizner
Charles University and University Hospital Kralovske Vinohrady
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Marketa Susankova
Charles University and University Hospital Kralovske Vinohrady
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Radka Prochazkova
Charles University and University Hospital Kralovske Vinohrady
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Ondrej Sussenbek
Charles University and University Hospital Kralovske Vinohrady
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Ivo Viscor
Institute of Scientific Instruments AS CR
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Vlastimil Vondra
Institute of Scientific Instruments AS CR
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Radovan Smisek
Czech Academy of Sciences
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Pavel Leinveber
St. Anne's University Hospital
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Pavel Osmancik
Charles University and University Hospital Kralovske Vinohrady
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Abstract

Background: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the UHF-ECG to describe ventricular depolarization when pacing different RV locations. Methods: In 51 consecutive patients, temporary pacing was performed at the RV apex, anterior and lateral wall, and at the RV septum with (cSp) and without direct conductive tissue engagement (mSp) (further subclassified as RVIT and RVOT for septal inflow and outflow positions). The timing of UHF-ECG electrical activations were quantified as: left ventricular lateral wall delay (LVLWd; V8 activation delay), RV lateral wall delay (RVLWd; V1 activation delay), and LV lateral wall depolarization duration (V5-8d). Results: The LVLWd was shortest for cSp (11 ms (95% CI; 5;17), followed by the RVIT (19 ms (11;26) and the RVOT (33 ms (27;40), (p<0.01 between all of them), although the QRSd for the latter two were the same (153 ms (148;158) vs. 153 ms (148; 158); p=0.99). The RVOT caused longer V5-8d (9 ms (3;14) compared to the RVIT (1 ms (−5;8), p<0.05. RV apical capture not only had a worse LVLWd (34 ms (26;43) compared to mSp (27 ms (20;34), p<0.05), but its RVLWd (17 ms (9;25) was also the longest compared to other RV pacing sites (mean values for cSp, mSp, anterior and lateral wall captures being below 6 ms), p<0.001 compared to each of them. Conclusions: UHF-ECG ventricular dyssynchrony parameters show that cSp offers the best ventricular synchrony followed by RVIT pacing, which should be preferred over RVOT and other RV myocardial pacing locations.

Peer review status:ACCEPTED

26 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
26 Nov 2020Submission Checks Completed
26 Nov 2020Assigned to Editor
30 Nov 2020Reviewer(s) Assigned
25 Dec 2020Review(s) Completed, Editorial Evaluation Pending
28 Dec 2020Editorial Decision: Revise Minor
10 Jan 20211st Revision Received
14 Jan 2021Assigned to Editor
14 Jan 2021Submission Checks Completed
14 Jan 2021Reviewer(s) Assigned
02 Feb 2021Review(s) Completed, Editorial Evaluation Pending
05 Feb 2021Editorial Decision: Revise Minor
14 Feb 20212nd Revision Received
15 Feb 2021Submission Checks Completed
15 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
22 Feb 2021Review(s) Completed, Editorial Evaluation Pending
23 Feb 2021Editorial Decision: Accept