Key result
A novel ECG algorithm based on paced QRS morphology demonstrated 90.3% agreement with echocardiography for right ventricular lead localization, with 92.5% sensitivity (95% CI 83.2-100.0%).
Why the study?
Fluoroscopy guidance alone is not sufficient for accurate pacing lead localization in the right ventricle during CIED implantation.
Does a novel ECG-based algorithm accurately determine right ventricular lead placement compared to echocardiography in pacemaker patients?
Observational (n=61)
Does a novel ECG-based algorithm accurately determine right ventricular lead placement compared to echocardiography in pacemaker patients?
Effect estimate: Sensitivity 92.5% (95% CI 83.2-100.0)
A simple surface ECG algorithm using leads I, II, V5, and V6 can reliably and accurately determine right ventricular pacing lead location, offering a useful adjunct to fluoroscopy during device implantation.
May support ECG as alternative to echocardiography for RV lead localization; hypothesis-generating and requires prospective validation before adoption.
INTRODUCTION: Fluoroscopy guidance alone is not sufficient for the accurate localization of the pacing lead (PL) in the right ventricle (RV) during implantation of the cardiac implantable electronic device (CIED). The aim of this study was to create a surface electrocardiogram (ECG) algorithm based on paced QRS (pQRS) morphology to accurately localize PL position in the RV. METHODS AND RESULTS: Thirty consecutive patients scheduled for catheter ablation of right heart arrhythmias were enrolled. After the elimination of index arrhythmia pacing from the RV interventricular septum (IVS), apex and free wall was performed and pQRS were recorded. The pacing site was verified both by fluoroscopy and transthoracic echocardiography. After a careful analysis of pQRS, a stepwise algorithm was developed to aid the proper positioning of the PL in RV. The algorithm was later prospectively validated in 31 pacemaker patients undergoing an elective generator exchange. A clear R wave in I, II, and V5 leads indicated proximal IVS. For a reliable indication of other RV sites, four ECG leads were crucial I, II, V5, and V6. A prospective evaluation of the algorithm revealed 90.3% agreement between RV lead localization obtained by ECG and echocardiography, with sensitivity of 92.5% (95% confidence interval [CI], 83.2%-100.0%) and a positive predictive value of 96.0% (95% CI, 89.0%-100.0%) for desired lead locations in RV. CONCLUSION: A simple ECG algorithm can reliably differentiate between the sites of permanent PL implantation in the RV in CIED recipients.
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Zając et al. (2019) conducted an observational in Right heart arrhythmias and permanent pacemaker patients (n=61). ECG algorithm based on paced QRS morphology vs. Echocardiography was evaluated on Agreement between RV lead localization obtained by ECG and echocardiography (Sensitivity 92.5%, 95% CI 83.2-100.0). A novel ECG algorithm based on paced QRS morphology demonstrated 90.3% agreement with echocardiography for right ventricular lead localization, with 92.5% sensitivity (95% CI 83.2-100.0%).
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