The effects of QRS duration and pacing sites on the acute hemodynamic changes during right ventricular pacing.
BACKGROUND
Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown.


METHODS
A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized.


RESULTS
During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r = 0.500, p = 0.001), the change of QRS duration post-pacing (r = 0.426, p = 0.001), and SBP during sinus rhythm (r = 0.342, p = 0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing.


CONCLUSIONS
Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.
Hong
Young Joon
YJ
The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangiu, Korea.
Yang
Bo Ra
BR
Sim
Doo Seon
DS
Lim
Sang Yup
SY
Lee
Sang Hyun
SH
Lim
Ji Hyun
JH
Kim
Han Gyun
HG
Park
Ok Young
OY
Kim
Ju Han
JH
Kim
Weon
W
Kim
Nam Ho
NH
Ahn
Young Keun
YK
Jeong
Myung Ho
MH
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D001794:Blood Pressure / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*