Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction

Sung Hwan Kim; Yong Seog Oh; Gi Byoung Nam; Kee Joon Choi; Jae Seok Park; Sang Weon Park; Seung Jung Park; Young Keun On; June Soo Kim; Woo Seung Shin; Ji Hoon Kim; Sung Won Jang; Man Young Lee; You Ho Kim; Tai Ho Rho

doi:10.1007/s10840-014-9950-7

Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction

Sung Hwan Kim
, Yong Seog Oh
, Gi Byoung Nam
, Kee Joon Choi
, Jae Seok Park
, Sang Weon Park
, Seung Jung Park
, Young Keun On
, June Soo Kim
, Woo Seung Shin
, Ji Hoon Kim
, Sung Won Jang
, Man Young Lee
, You Ho Kim
, Tai Ho Rho

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Purpose: The selection of the optimal right ventricular (RV) pacing site remains unclear. We hypothesized that a normal paced QRS axis would provide a physiological ventricular activation and lead to a better long-term outcome.

Methods: We evaluated 187 patients who underwent a permanent pacemaker implantation and were dependent on RV pacing. The pacing sites were classified as the apex and non-apex according to the chest radiography. A paced QRS axis was defined as that between −30° and 90°. Preservation of the left ventricular (LV) systolic function was defined as that with a <10 % decrease in the ejection fraction after the pacemaker implantation.

Results: The median follow-up period was 5.8 years (interquartile 3.9–9.0). Radiographically, the RV leads were located in the apex (n = 148, 79 %) or non-apex (n = 39, 21 %). In the electrocardiogram, normal paced and abnormal paced QRS axes were observed in 28 patients (15 %) and 159 patients (85 %), respectively. The LV ejection fraction was decreased in the patients with an abnormal paced QRS axis (−10 ± 10 %, P < 0.001), but not in those with a normal axis (0 ± 6 %, P = 0.80). The electrocardiographic determinant differentiated a preserved LV function (95 % vs. 35 %, log-rank P = 0.04). Among the patients with radiographically non-apical pacing, a normal paced QRS axis was an additional meaningful predictor of a preserved LV function after the pacemaker implantation (95 % vs. 24 %, log-rank P = 0.002).

Conclusion: Compared with the radiographic method, a normal paced QRS axis was associated with a preserved LV function.

Original language	English
Pages (from-to)	223-229
Number of pages	7
Journal	Journal of Interventional Cardiac Electrophysiology
Volume	41
Issue number	3
DOIs	https://doi.org/10.1007/s10840-014-9950-7
State	Published - 9 Dec 2014

Keywords

Electrocardiography
Heart failure
Pacemaker
Pacing-induced cardiomyopathy

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Kim, S. H., Oh, Y. S., Nam, G. B., Choi, K. J., Park, J. S., Park, S. W., Park, S. J., On, Y. K., Kim, J. S., Shin, W. S., Kim, J. H., Jang, S. W., Lee, M. Y., Kim, Y. H., & Rho, T. H. (2014). Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction. Journal of Interventional Cardiac Electrophysiology, 41(3), 223-229. https://doi.org/10.1007/s10840-014-9950-7

@article{f3f946e68db142c9b296d04b4dc40319,

title = "Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction",

abstract = "Purpose: The selection of the optimal right ventricular (RV) pacing site remains unclear. We hypothesized that a normal paced QRS axis would provide a physiological ventricular activation and lead to a better long-term outcome.Methods: We evaluated 187 patients who underwent a permanent pacemaker implantation and were dependent on RV pacing. The pacing sites were classified as the apex and non-apex according to the chest radiography. A paced QRS axis was defined as that between −30° and 90°. Preservation of the left ventricular (LV) systolic function was defined as that with a <10 \% decrease in the ejection fraction after the pacemaker implantation.Results: The median follow-up period was 5.8 years (interquartile 3.9–9.0). Radiographically, the RV leads were located in the apex (n = 148, 79 \%) or non-apex (n = 39, 21 \%). In the electrocardiogram, normal paced and abnormal paced QRS axes were observed in 28 patients (15 \%) and 159 patients (85 \%), respectively. The LV ejection fraction was decreased in the patients with an abnormal paced QRS axis (−10 ± 10 \%, P < 0.001), but not in those with a normal axis (0 ± 6 \%, P = 0.80). The electrocardiographic determinant differentiated a preserved LV function (95 \% vs. 35 \%, log-rank P = 0.04). Among the patients with radiographically non-apical pacing, a normal paced QRS axis was an additional meaningful predictor of a preserved LV function after the pacemaker implantation (95 \% vs. 24 \%, log-rank P = 0.002).Conclusion: Compared with the radiographic method, a normal paced QRS axis was associated with a preserved LV function.",

keywords = "Electrocardiography, Heart failure, Pacemaker, Pacing-induced cardiomyopathy",

author = "Kim, \{Sung Hwan\} and Oh, \{Yong Seog\} and Nam, \{Gi Byoung\} and Choi, \{Kee Joon\} and Park, \{Jae Seok\} and Park, \{Sang Weon\} and Park, \{Seung Jung\} and On, \{Young Keun\} and Kim, \{June Soo\} and Shin, \{Woo Seung\} and Kim, \{Ji Hoon\} and Jang, \{Sung Won\} and Lee, \{Man Young\} and Kim, \{You Ho\} and Rho, \{Tai Ho\}",

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doi = "10.1007/s10840-014-9950-7",

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T1 - Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction

AU - Kim, Sung Hwan

AU - Oh, Yong Seog

AU - Nam, Gi Byoung

AU - Choi, Kee Joon

AU - Park, Jae Seok

AU - Park, Sang Weon

AU - Park, Seung Jung

AU - On, Young Keun

AU - Kim, June Soo

AU - Shin, Woo Seung

AU - Kim, Ji Hoon

AU - Jang, Sung Won

AU - Lee, Man Young

AU - Kim, You Ho

AU - Rho, Tai Ho

PY - 2014/12/9

Y1 - 2014/12/9

N2 - Purpose: The selection of the optimal right ventricular (RV) pacing site remains unclear. We hypothesized that a normal paced QRS axis would provide a physiological ventricular activation and lead to a better long-term outcome.Methods: We evaluated 187 patients who underwent a permanent pacemaker implantation and were dependent on RV pacing. The pacing sites were classified as the apex and non-apex according to the chest radiography. A paced QRS axis was defined as that between −30° and 90°. Preservation of the left ventricular (LV) systolic function was defined as that with a <10 % decrease in the ejection fraction after the pacemaker implantation.Results: The median follow-up period was 5.8 years (interquartile 3.9–9.0). Radiographically, the RV leads were located in the apex (n = 148, 79 %) or non-apex (n = 39, 21 %). In the electrocardiogram, normal paced and abnormal paced QRS axes were observed in 28 patients (15 %) and 159 patients (85 %), respectively. The LV ejection fraction was decreased in the patients with an abnormal paced QRS axis (−10 ± 10 %, P < 0.001), but not in those with a normal axis (0 ± 6 %, P = 0.80). The electrocardiographic determinant differentiated a preserved LV function (95 % vs. 35 %, log-rank P = 0.04). Among the patients with radiographically non-apical pacing, a normal paced QRS axis was an additional meaningful predictor of a preserved LV function after the pacemaker implantation (95 % vs. 24 %, log-rank P = 0.002).Conclusion: Compared with the radiographic method, a normal paced QRS axis was associated with a preserved LV function.

AB - Purpose: The selection of the optimal right ventricular (RV) pacing site remains unclear. We hypothesized that a normal paced QRS axis would provide a physiological ventricular activation and lead to a better long-term outcome.Methods: We evaluated 187 patients who underwent a permanent pacemaker implantation and were dependent on RV pacing. The pacing sites were classified as the apex and non-apex according to the chest radiography. A paced QRS axis was defined as that between −30° and 90°. Preservation of the left ventricular (LV) systolic function was defined as that with a <10 % decrease in the ejection fraction after the pacemaker implantation.Results: The median follow-up period was 5.8 years (interquartile 3.9–9.0). Radiographically, the RV leads were located in the apex (n = 148, 79 %) or non-apex (n = 39, 21 %). In the electrocardiogram, normal paced and abnormal paced QRS axes were observed in 28 patients (15 %) and 159 patients (85 %), respectively. The LV ejection fraction was decreased in the patients with an abnormal paced QRS axis (−10 ± 10 %, P < 0.001), but not in those with a normal axis (0 ± 6 %, P = 0.80). The electrocardiographic determinant differentiated a preserved LV function (95 % vs. 35 %, log-rank P = 0.04). Among the patients with radiographically non-apical pacing, a normal paced QRS axis was an additional meaningful predictor of a preserved LV function after the pacemaker implantation (95 % vs. 24 %, log-rank P = 0.002).Conclusion: Compared with the radiographic method, a normal paced QRS axis was associated with a preserved LV function.

KW - Electrocardiography

KW - Heart failure

KW - Pacemaker

KW - Pacing-induced cardiomyopathy

UR - https://www.scopus.com/pages/publications/84916221199

U2 - 10.1007/s10840-014-9950-7

DO - 10.1007/s10840-014-9950-7

M3 - Article

C2 - 25380704

AN - SCOPUS:84916221199

SN - 1383-875X

VL - 41

SP - 223

EP - 229

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

IS - 3

ER -

Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction

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