Key result
Permanent RVP is linked to increasing QRS dispersion, with a 47 ms cutoff predicting LV dysfunction.
Why the study?
Permanent right ventricular apical pacing may negatively affect ventricular function and contribute to heart failure, prompting evaluation of mechanical dyssynchrony and associated electrocardiographic markers.
Does QRS dispersion predict left ventricular dysfunction and mechanical dyssynchrony in patients with permanent right ventricular apical pacing?
Observational (n=84)
No
Does QRS dispersion predict left ventricular dysfunction and mechanical dyssynchrony in patients with permanent right ventricular apical pacing?
Absolute Event Rate: 46.13% vs 43.26%
p-value: p=<0.000
QRS dispersion is a simple and effective electrocardiographic marker for predicting left ventricular dysfunction and mechanical dyssynchrony in patients with permanent right ventricular apical pacing.
QRS dispersion may flag LV dysfunction risk after RV apical pacing; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Permanent right ventricular apical pacing may have negative effects on ventricular function and contribute to development of heart failure. We aimed to assess intra- and interventricular mechanical dyssynchrony in patients with permanent right ventricular apical pacing, and to establish electrocardiographic markers of dyssynchrony. METHODS: 84 patients (46:38 male:female) who required permanent pacing were studied. Pacing was done from right ventricular apex in all patients. We measured QRS duration and dispersion on standard 12-lead ECG. Intra- and interventricular mechanical dyssynchrony and left ventricular ejection fraction were assessed by transthoracic echocardiography. Patients were followed-up for 24 months. Results: Six months after implantation, QRS duration increased from 128.02 ms to 132.40 ms, p≤0.05. At 24 months, QRS dispersion increased from 43.26 ms to 46.13 ms, p≤0.05. Intra- and interventricular dyssynchrony increased and left ventricular ejection fraction decreased during follow-up. A QRS dispersion of 47 ms predicted left ventricular dysfunction and long-term electromechanical dyssynchrony with a sensitivity of 80% and a specificity of 76%. Conclusion: In patients with permanent right ventricular apical pacing there is an increased duration and dispersion of QRS related to dyssynchrony and decreased left ventricular ejection fraction. This study shows that QRS dispersion could be a better predictive variable than QRS duration for identifying left ventricular ejection fraction worsening in patients with permanent right ventricular apical pacing. The electrocardiogram is a simple tool for predicting systolic function worsening in these patients and can be used at the bedside for early diagnosis in the absence of clinical symptoms, allowing adjustments of medical treatment to prevent progression of heart failure and improve the patient's quality of life.
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Chávez-González et al. (2021) conducted an observational in Permanent right ventricular apical pacing (n=84). Permanent right ventricular apical pacing vs. 6 months post-implantation was evaluated on QRS dispersion (ms) (p=<0.000). Permanent right ventricular apical pacing significantly increased QRS dispersion from 43.26 ms at 6 months to 46.13 ms at 24 months, with a cut-off of 47 ms predicting left ventricular dysfunction.
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