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Structural heart disease, not the right ventricular pacing site, determines the QRS duration during right ventricular pacing

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Abstract

Right ventricular (RV) pacing causes changes in the heart’s electrical and mechanical activation patterns. The QRS duration is a useful surrogate marker of electrical dyssynchrony; a longer QRS duration during RV pacing indicates poor prognosis. However, the mechanisms underlying a longer QRS duration during RV pacing remain unclear; hence, we investigated factors predicting QRS prolongation during RV pacing. We enrolled 211 patients who underwent catheter ablation for supraventricular tachyarrhythmia and showed no bundle branch block. Three-dimensional mapping for the QRS duration during RV pacing from the RV outflow to RV apex was performed, and differences in the QRS duration were analyzed. The predisposing factors causing QRS > 160 ms during RV apical pacing were also analyzed. The QRS durations at baseline and during RV pacing from the RV outflow and at the RV apex were 85.0 ± 7.5 ms, 163.7 ± 17.1 ms, and 156.2 ± 16.1 ms, respectively. With respect to the QRS duration, there was a significant correlation between RV outflow and RV apical pacing (r = 0.658, p < 0.001). Difference in the QRS duration between the RV outflow and RV apex in each patient was only 12.5 ± 10.4 ms. Logistic multivariable regression analysis identified baseline QRS duration [odds ratio (OR) 1.24, 95% confidence interval (CI) 1.15–1.33, p < 0.01], interventricular septum thickness (OR 1.20, 95% CI 1.02–1.40, p = 0.025), left atrial diameter (OR 1.08, 95% CI 1.01–1.16, p = 0.024), and E/e’ (OR 1.23, 95% CI 1.12–1.35, p < 0.01) as significant predictors of QRS prolongation during RV apical pacing. The QRS duration during RV pacing largely depends not on the pacing site, but on the underlying structural heart diseases.

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Data availability

The data and study materials will be made available from the corresponding author to other researchers at reasonable request.

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Acknowledgements

The authors thank Noboru Kitamura and Takeru Takada for technical assistance and support during the pacing study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto, Shizuoka, 4110906, Japan

    Michio Ogano & Jun Tanabe

  2. Department of Cardiovascular Medicine, Nippon Medical School Musasikosugi Hospital, 1-396 Kosugi-cho, Nakahar-ku, Kawasaki, Kanagawa, 2118533, Japan

    Ippei Tsuboi

  3. Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, 1138603, Japan

    Yu-ki Iwasaki & Wataru Shimizu

Authors
  1. Michio Ogano
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  2. Ippei Tsuboi
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  3. Yu-ki Iwasaki
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  4. Jun Tanabe
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  5. Wataru Shimizu
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Contributions

MO: contributed to the conception of the study, performed all electrophysiological and hemodynamic studies, collected data, analyzed all data, and wrote the first draft of the paper. IT: assisted with the hemodynamic study, followed up the patients, and collected data. YI: assisted with the interpretation of the data, provided critical analysis, and supervised the writing/composition of the manuscript, and corrected the text and figures in the paper. JT: assisted with device implantation and followed up the patients. WS: supervised this study and critically reviewed the manuscript.

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Correspondence to Michio Ogano.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Shizouka Medical Center ethics committee (18-13) and conducted in accordance with the Declaration of Helsinki.

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All patients provided written informed consent to participate.

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Ogano, M., Tsuboi, I., Iwasaki, Yk. et al. Structural heart disease, not the right ventricular pacing site, determines the QRS duration during right ventricular pacing. Heart Vessels 36, 1870–1878 (2021). https://doi.org/10.1007/s00380-021-01881-4

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  • DOI: https://doi.org/10.1007/s00380-021-01881-4

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