Skip to main content
SpringerLink
Log in

Impact of simple electrocardiographic markers as predictors for deterioration of left ventricular function in patients with frequent right ventricular apical pacing

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Several trials demonstrated that frequent right ventricular apical pacing (RVAP) was associated with cardiac dysfunction and an increased rate of heart failure hospitalization. However, there are few reports about the 12-lead electrocardiogram (12-ECG) parameters at the time of device implantation to predict deterioration of LVEF in patients with frequent RVAP. We retrospectively studied 115 consecutive patients undergoing pacemaker or implantable cardioverter-defibrillator implantation with RVAP, with rate of ventricular pacing ≥ 40% and LVEF ≥ 50% at the time of implantation. We compared the 12-ECG characteristics at the time of device implantation between patients with deterioration of LVEF (≥ 10% reduction) and those without. Twenty-nine patients (25%) had deteriorated LVEF with a decrease in mean LVEF from 59 to 40% during a median follow-up period of 8.9 [4.6–13.7] years. Multivariate logistic regression analysis showed that cumulative % of ventricular pacing [odds ratio (OR) 1.04 per 1% increase, 95% confidence interval (CI) 1.01–1.09, p = 0.04], notching of baseline paced QRS in limb leads (OR 5.04, 95% CI 1.59–19.6, p = 0.005) and the QS pattern in all precordial leads (OR 3.56, 95% CI 1.21–10.8, p = 0.02) were independently associated with deterioration of LVEF. The QS pattern of baseline paced QRS in all precordial leads had 58% sensitivity, 93% specificity for the RV lead position at the tip of RV apex. In conclusion, considering OR by multivariate analysis, notching of baseline paced QRS in limb leads and the QS pattern in all precordial leads at device implantation may be simple and useful predictors to identify patients who are at risk for deterioration of cardiac function during long-term RVAP. 12-ECG monitoring at device implantation and avoidance of the RVAP site showing a QS pattern may be important to prevent deterioration of cardiac function in patients with frequent RVAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Prinzen FW, Peschar M (2002) Relation between the pacing induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol 25:484–498

    Article  PubMed  Google Scholar 

  2. Thackray SD, Witte KK, Nikitin NP, Clark AL, Kaye GC, Cleland JG (2003) The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population. Eur Heart J 24:1143–1152

    Article  PubMed  Google Scholar 

  3. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, MOde Selection Trial Investigators (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107:2932–2937

    Article  PubMed  Google Scholar 

  4. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A, Chamber Dual, Implantable Defibrillator Trial Investigators VVI (2002) Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and VVI implantable defibrillator (DAVID) trial. JAMA 288:3115–3123

    Article  PubMed  Google Scholar 

  5. Miyoshi F, Kobayashi Y, Itou H, Onuki T, Matsuyama T, Watanabe N, Liu C, Kawamura M, Asano T, Miyata A, Nakagawa H, Tanno K, Baba T, Katagiri T (2005) Prolonged paced QRS duration as a predictor for congestive heart failure in patients with right ventricular apical pacing. Pacing Clin Electrophysiol 28:1182–1188

    Article  PubMed  Google Scholar 

  6. Chen S, Yin Y, Lan X, Liu Z, Ling Z, Su L, Kiuchi MG, Li X, Zhong B, Krucoff MW (2013) Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF). Eur J Heart Fail 15:352–359

    Article  PubMed  Google Scholar 

  7. Sweeney MO, Hellkamp AS (2006) Heart failure during cardiac pacing. Circulation 113:2082–2088

    Article  PubMed  Google Scholar 

  8. Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, Frankel DS (2014) Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart rhythm 11:1619–1625

    Article  PubMed  Google Scholar 

  9. Lee SA, Cha MJ, Cho Y, Oh IY, Choi EK, Oh S (2016) Paced QRS duration and myocardial scar amount: Predictors of long-term outcome of right ventricular apical pacing. Heart Vessel 31:1131–1139

    Article  Google Scholar 

  10. Pang BJ, Joshi SB, Lui EH, Tacey MA, Ling LH, Alison J, Seneviratne SK, Cameron JD, Mond HG (2014) Validation of conventional fluoroscopic and ECG criteria for right ventricular pacemaker lead position using cardiac computed tomography. Pacing Clin Electrophysiol 37:495–504

    Article  PubMed  Google Scholar 

  11. Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dandamudi G, Mahenthiran J (2008) Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 1:258–268

    Article  PubMed  Google Scholar 

  12. Lee KH, Cho JG, Park HW, Yoon NS, Kim SS, Kim MR, Kim MC, Cho KH, Kim HK, Kim CH, Kim KH, Jun SJ, Kim WJ, Lee KJ, Jeong HC, Cho JY, Park KH, Ds Sim, Yoon HJ, Kim KH, Hong YJ, Kim JH, Ahn Y, Jeong MH, Park JC (2014) QRS morphology and ventricular dyssynchrony in patients with chronic right ventricular pacing. Int J Cardiol 176:962–968

    Article  PubMed  Google Scholar 

  13. Fujiwara S, Komamura K, Nakabo A, Masaki M, Fukui M, Sugahara M, Itohara K, Soyama Y, Goda A, Hirotani S, Mano T, Masuyama T (2016) The association between left ventricular twisting motion and mechanical dyssynchrony: a three-dimensional speckle tracking study. Heart Vessel 31:158–164

    Article  Google Scholar 

  14. Alhous MH, Small GR, Hannah A, Hillis GS, Broadhurst P (2011) Impact of temporary right ventricular pacing from different sites on echocardiographic indices of cardiac function. Europace 13:1738–1746

    Article  PubMed  Google Scholar 

  15. Vancura V, Wichterle D, Melenovsky V, Kautzner J (2013) Assessment of optimal right ventricular pacing site using invasive measurement of left ventricular systolic and diastolic function. Europace 15:1482–1490

    Article  PubMed  Google Scholar 

  16. Shukla HH, Hellkamp AS, James EA, Flaker GC, Lee KL, Sweeney MO, Lamas GA (2005) Heart failure hospitalization is more common in pacemaker patients with sinus node dysfunction and a prolonged paced QRS duration. Heart rhythm 2:245–251

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Yusuke Hayashi, Masahiko Takagi, Jun Kakihara, Shogo Sakamoto, Hiroaki Tatsumi, Atsushi Doi, Shinichi Iwata, Kenichi Sugioka & Minoru Yoshiyama

Authors
  1. Yusuke Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiko Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Kakihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shogo Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroaki Tatsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Doi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shinichi Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenichi Sugioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Minoru Yoshiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masahiko Takagi.

Ethics declarations

Conflict of interest

All authors delcare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayashi, Y., Takagi, M., Kakihara, J. et al. Impact of simple electrocardiographic markers as predictors for deterioration of left ventricular function in patients with frequent right ventricular apical pacing. Heart Vessels 33, 299–308 (2018). https://doi.org/10.1007/s00380-017-1052-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-017-1052-x

Keywords

Search

Navigation