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Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block

Abstract

Background

The presence of left bundle branch block (LBBB) represents a particular challenge in properly measuring the QT interval. Here we demonstrate the applicability of the “Bogossian formula” in pacemaker patients with LBBB due to apical or nonapical right ventricular (RV) pacing and preserved left ventricular function.

Methods

A total of 163 patients with a cardiac one- or two-chamber pacemaker were included in this prospective, multicentre observational study. Twelve-lead ECG recordings were obtained during both intrinsic rhythm and RV pacing with induced LBBB. The QT interval measured during LBBB was corrected using the Bogossian formula to obtain the “modified QT” (QTm). The QTmc interval was calculated with the Bazett formula, and this was compared with the QTc interval during intrinsic rhythm.

Results

Eighty-three patients (78 ± 9 years; male n = 83) with apical and eighty patients (71 ± 13 years; male n = 80) with non-apical RV pacing were included in this study. In the apical group the QTmc was determined to be 444 ± 39 ms in paced rhythm and the QTc interval 413 ± 36 ms in intrinsic rhythm. In the non-apical group these values were 430 ± 34 ms in paced and 416 ± 32 ms in intrinsic rhythm.

Conclusion

The Bogossian formula is a reliable tool for QTc interval evaluation in pacemaker patients with LBBB due to apical or non-apical RV pacing. However, an overestimation of 30 ms should be included in the calculation.

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References

  1. Woosley RL, Romero K (2013) Assessing cardiovascular drug safety for clinical decision-making. Nat Rev Cardiol 10(6):330–337

    Article  Google Scholar 

  2. Schneider JF, Thomas HE Jr, McNamara PM, Kannel WB (1985) Clinical-electrocardiographic correlates of newly acquired left bundle branch block: the Framingham Study. Am J Cardiol 55(11):1332–1338

    CAS  Article  Google Scholar 

  3. Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS et al (2014) New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm 11(12):2273–2277

    Article  Google Scholar 

  4. Bogossian H, Frommeyer G, Ninios I, Hasan EP F, et al.: A new experimentally validated formula to calculate the QT-interval in the presence of left bundle branch block holds true in the clinical setting. Ann Noninvasive Electrocardiol. 2016 in press

  5. Markewitz A (2015) Annual report 2013 of the German Cardiac Pacemaker And Defibrillator Register–Part 2: implantable cardioverter-defibrillators. Pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH workgroup. Herzschrittmacherther Elektrophysiol. 26(4):399–423

    CAS  Article  Google Scholar 

  6. Markewitz A (2015) Annual report 2013 of the German Cardiac Pacemaker and Defibrillator Register, part 1–Pacemaker. Pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH workgroup. Herzschrittmacherther Elektrophysiol 26(4):374–398

    CAS  Article  Google Scholar 

  7. Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 119(10):e241-e250

    Article  Google Scholar 

  8. Postema PG, De Jong JS, Van der Bilt IA, Wilde AA (2008) Accurate electrocardiographic assessment of the QT interval: teach the tangent. Heart Rhythm 5(7):1015–1018

    Article  Google Scholar 

  9. Nielsen JB, Graff C, Rasmussen PV, Pietersen A, Lind B et al (2014) Risk prediction of cardiovascular death based on the QTc interval: evaluating age and gender differences in a large primary care population. Eur Heart J 35(20):1335–1344

    Article  Google Scholar 

  10. Priori SG, Schwartz PJ, Napolitano C, Bloise R, Ronchetti E et al (2003) Risk stratification in the long-QT syndrome. N Engl J Med 348(19):1866–1874

    Article  Google Scholar 

  11. Rautaharju PM, Zhang ZM, Prineas R, Heiss G (2004) Assessment of prolonged QT and JT intervals in ventricular conduction defects. Am J Cardiol 93(8):1017–1021

    Article  Google Scholar 

  12. Chakravarty S, Kluger J, Chhabra L, Ramu B, Coleman C (2015) Corrected QT in ventricular paced rhythms: what is the validation for commonly practiced assumptions? Cardiology 130(4):207–210

    Article  Google Scholar 

  13. Frommeyer G, Bogossian H, Pechlivanidou E, Conzen P, Gemein C et al (2017) Applicability of a novel formula (Bogossian formula) for evaluation of the QT-interval in heart failure and left bundle branch block due to right ventricular pacing. Pacing Clin Electrophysiol 40(4):409–416

    Article  Google Scholar 

  14. Frommeyer G, Milberg P, Witte P, Stypmann J, Koopmann M et al (2011) A new mechanism preventing proarrhythmia in chronic heart failure: rapid phase-III repolarization explains the low proarrhythmic potential of amiodarone in contrast to sotalol in a model of pacing-induced heart failure. Eur J Heart Fail 13(10):1060–1069

    CAS  Article  Google Scholar 

  15. Frommeyer G, Rajamani S, Grundmann F, Stypmann J, Osada N et al (2012) New insights into the beneficial electrophysiologic profile of ranolazine in heart failure: prevention of ventricular fibrillation with increased postrepolarization refractoriness and without drug-induced proarrhythmia. J Card Fail 18(12):939–949

    CAS  Article  Google Scholar 

  16. Vrtovec B, Ryazdanbakhsh AP, Pintar T, Collard CD, Gregoric ID, Radovancevic B (2006) QTc interval prolongation predicts postoperative mortality in heart failure patients undergoing surgical revascularization. Texas Heart Inst J 33(1):3–8

    Google Scholar 

  17. Inoue K, Okayama H, Nishimura K, Saito M, Yoshii T et al (2011) Right ventricular septal pacing preserves global left ventricular longitudinal function in comparison with apical pacing: analysis of speckle tracking echocardiography. Circ J 75(7):1609–1615

    Article  Google Scholar 

  18. Pang BJ, Kumar S, Tacey MA, Mond HG (2014) Capturing the His-Purkinje system is not possible from conventional right ventricular apical and nonapical pacing sites. Pacing Clin Electrophysiol 37(6):724–730

    Article  Google Scholar 

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Acknowledgements

We thank Inga Bayh and Prof. Dr. Frank Krummenauer (Institute for Medical Biometry and Epidemiology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany) for statistical advice.

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Correspondence to D. Erkapic.

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Weipert, K.F., Bogossian, H., Conzen, P. et al. Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block. Clin Res Cardiol 107, 1033–1039 (2018). https://doi.org/10.1007/s00392-018-1275-6

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  • DOI: https://doi.org/10.1007/s00392-018-1275-6

Keywords

  • QT formula
  • Left bundle branch block
  • QT interval
  • JT interval
  • Long QT
  • Pacemaker