Wide QRS complex and left ventricular lateral repolarization abnormality: The importance of ECG markers on outcome prediction in patients with COVID-19

Abstract Background Right ventricular apical pacing with the resultant left ventricular dyssynchrony often leads to depressed systolic function and heart failure. This study aimed at investigating the relation between various septal locations guided by ECG and fluoroscopy and the intermediate term functional capacity of the patients. Results Fifty patients who received a single lead pacemaker with assumed > 90% pacemaker dependency. Patients were randomized according to RV pacing site RV into group 1 “high septum” (n = 15), group 2 “mid septum” (n = 25), and group 3 “low septum” (n = 10) using QRS vector and duration as well as fluoroscopic parameters. Their clinical status was assessed 6 months after device implementation using 6-min walk test (6MWT). The study showed that paced QRS complex duration itself has no significant difference between the different septal pacing locations (P-value 0.675), although its combination with the paced QRS complex vector can signify the optimal pacing site and 6MWT showed a significant difference among the groups in favor of group 1; group 1 (413.3 ± 148.5), group 2 (359.8 ± 124.6), and group 3 (276.0 ± 98.5) P value 0.04. Conclusion There was a significant difference found between the three septal pacing sites concerning the patient functional capacity with superiority of high septal location. By contrast, different septal sites showed no significant difference of the paced QRS complex duration. To optimize the pacing site in the septum, assessment of the paced QRS vector in leads I and III is of a great benefit especially when combined with paced QRS complex duration assessment.

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Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap64 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Phillip E Schrumpf ◽

Michael Giudici ◽

Deborah Paul ◽

Roselyn Krupa ◽

Cynthia Meirbachtol

Keyword(s):

Cardiac Resynchronization Therapy ◽

Right Ventricular ◽

Right Bundle Branch Block ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Resynchronization Therapy ◽

Ventricular Performance ◽

Bundle Branch Block ◽

Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

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Left ventricular diastolic and systolic dyssynchrony and dysfunction in heart failure with preserved ejection fraction and a narrow QRS complex

International Journal of Medical Sciences ◽

10.7150/ijms.21956 ◽

2018 ◽

Vol 15 (2) ◽

pp. 108-114 ◽

Cited By ~ 8

Author(s):

Shuang Liu ◽

Zhengyu Guan ◽

Xuanyi Jin ◽

Pingping Meng ◽

Yonghuai Wang ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Qrs Complex ◽

Narrow Qrs ◽

Narrow Qrs Complex

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968 Frequency of left ventricular dyssynchrony in patients with advanced heart failure and a QRS complex =< 120 ms

EP Europace ◽

10.1016/eupace/7.supplement_1.228 ◽

2005 ◽

Vol 7 (Supplement_1) ◽

pp. 228-228

Author(s):

G. Bleeker ◽

S.G. Molhoek ◽

H.F. Verwey ◽

E.R. Holman ◽

P. Steendijk ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Left Ventricular Dyssynchrony ◽

Qrs Complex ◽

Ventricular Dyssynchrony

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A Case Report on Osborn Waves of Hypothermia Induced LV Systolic Dysfunction

International Journal of Pharmaceutical Sciences Review and Research ◽

10.47583/ijpsrr.2021.v70i02.004 ◽

2021 ◽

Vol 70 (2) ◽

Author(s):

Rajnandini Singha ◽

Amazing Grace Siangshai ◽

Jashlyn Lijo

Keyword(s):

Body Temperature ◽

Sinus Bradycardia ◽

Core Body Temperature ◽

Systolic Dysfunction ◽

Left Ventricular ◽

The Body ◽

Qrs Complex ◽

Pr Interval ◽

Gradual Expansion ◽

Core Body

Hypothermia, described as a core body temperature of < 95%, is associated with ECG alteration abnormalities. Sinus bradycardia occurs when the body temperature drops below 90°F, and is correlated with gradual prolongation of the PR interval, QRS complex, QT interval. It can progress to ventricular and atrial fibrillation at a temperature reaching 89°F, which can lead to left ventricular dysfunction. Hypothermia is connected to the osborn waves, which at the end of the QRS complex consist of additional deflection. The inferior and lateral precordial leads are seen by Osborn waves, also known as J waves, Camel hump waves and hypothermic waves. As the body temperature decreases, it becomes more pronounced and a gradual expansion of the QRS complex raises the likelihood of ventricular fibrillation causing ventricle dysfunction.

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Narrow QRS complex in idiopathic (fascicular) left ventricular tachycardia

Herz ◽

10.1007/s00059-013-3954-4 ◽

2013 ◽

Vol 40 (1) ◽

pp. 147-149 ◽

Cited By ~ 4

Author(s):

S. Paraskevaidis ◽

E.K. Theofilogiannakos ◽

D.M. Konstantinou ◽

L. Mantziari ◽

C. Kefalidis ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Qrs Complex ◽

Narrow Qrs ◽

Narrow Qrs Complex

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Abstract 16382: The Surface ECG May Provide Information About Left Ventricular Systolic Function in Patients With Right Bundle Branch Block

Circulation ◽

10.1161/circ.142.suppl_3.16382 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anshul Gupta ◽

Behzad B Pavri

Keyword(s):

Right Bundle Branch Block ◽

Visual Recognition ◽

Visual Analysis ◽

Systolic Function ◽

Left Ventricular ◽

Lv Function ◽

Qrs Complex ◽

Bundle Branch Block ◽

Transition Group ◽

Surface Ecg

Introduction: In patients (pts) with right bundle branch block (RBBB) and heart failure, assessment of left ventricular (LV) function is vital to management, but echocardiograms (ECHO) may not always be readily available. We studied the utility of using the Superimposed Median Format (available on digital ECG systems) in assessing LV function. This format allows visual recognition of change in dV/dT when rapid initial impulse propagation over the left bundle branch (LBB) and LV Purkinje network transitions to slower muscle-to-muscle propagation to the right ventricle (RV) in the setting of RBBB. Hypothesis: With a normal LBB and healthy LV myocardium, the transition from rapid forces to slower depolarization would occur in the 1 st half of the QRS complex ( Early Transition Group - ET) whereas in patients with abnormal LV function, this transition would occur in the 2 nd half (Late Transition Group - LT) of the QRS complex. Methods: Digital superimposed median format ECGs of 108 pts with RBBB were analyzed. Pts were divided into 2 groups: ET or LT. See figure. LVEFs were obtained from ECHO. LVEF ≥ 50% was considered normal. Results: ET: n = 69. LT: n = 39. Mean QRS durations were not different in the 2 groups. ET pts were more likely to have normal LVEF (p < 0.01). See figure. PPV of ET in predicting LVEF ≥50% = 90%; NPV = 71%. Accuracy = 82%. Conclusions: These data, if confirmed, suggest that in pts with RBBB, visual analysis of the QRS complex from the surface ECG using the superimposed median format may provide valuable clues about LV systolic function, and may be clinically useful when ECHO are not readily available.

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