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ISSN 1561-2937 (Print)

2022, Number 4

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Rev Cubana Cardiol Cir Cardiovasc 2022; 28 (4)

Electrocardiographic markers for septal stimulation of the right ventricular outflow tract

Cruz CM, Cort Z, Mengana BA, Blanco PY, Soto GZ, Gutiérrez LA

Language: Spanish
References: 16
Page: 1-8
PDF size: 720.32 Kb.


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.


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