Electrocardiogram-based algorithm to predict the left ventricular lead position in recipients of cardiac resynchronization systems.
BACKGROUND
Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram-based algorithm to predict the position of the LV lead.


METHODS
The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions. The algorithm was prospectively validated in 50 consecutive CRT device recipients.


RESULTS
The first analysis of the algorithm was the QRS morphology in V(1). A positive R wave in V(1) suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V(1), V(6) was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V(6). To differentiate between lateral and posterior positions, we analyzed the pattern in V(2). Lateral leads were associated with an R morphology in V(1) and a negative V(2). Posterior leads were associated with an R morphology in V(1) and V(2). The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients.


CONCLUSIONS
This algorithm predicted the position of the LV lead with a high sensitivity and predictive value.
Ploux
Sylvain
S
University Victor Segalen, Bordeaux, and Hospital Haut Leveque, Pessac, France.
Bordachar
Pierre
P
Deplagne
Antoine
A
Mokrani
Bilel
B
Reuter
Sylvain
S
Laborderie
Julien
J
Garrigue
Stephane
S
Delarche
Nicolas
N
Jais
Pierre
P
Haissaguerre
Michel
M
Clementy
Jacques
J
D000368:Aged; D000465:Algorithms; D018780:Body Surface Potential Mapping / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013813:Therapy, Computer-Assisted / Q000379:methods; D016277:Ventricular Function, Left