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33/Left ventricular pacing vector optimisation in an ideally deployed quadripolar lead in cardiac resynchronisation therapy: effect of optimising QRS area

Published Online: October 4th 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr33
Authors: O Okafor (Presenting Author) – Aston University, Birmingham, UK; F Umar – University of Birmingham, Birmingham, UK; P M van Dam – University Medical Centre, Utrecht, The Netherlands; J Walton – Queen Elizabeth Hospital, Birmingham, UK; B Stegemann – Aston University, Birmingham, UK; A Zegard – Aston University, Birmingham, UK; M Lencioni – Queen Elizabeth Hospital, Birmingham, UK; J de Bono – Queen Elizabeth Hospital, Birmingham, UK; H Marshall – Queen Elizabeth Hospital, Birmingham, UK; F Leyva – Queen Elizabeth Hospital, Birmingham, UK
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Background: QRS area (QRSarea), derived from vectorcardiography (VCG) is a marker of delayed left ventricular (LV) activation.

Objective: To determine whether changes in QRS area (ΔQRSarea) in LV lead vectors of a quadripolar lead (QUAD) relates to the acute haemodynamic response (AHR) to CRT.

Methods: In this acute study, we performed 12-lead ECGs and measured LV pressure (LV dP/dtmax) in 25 CRT recipients (age: 69 ± [9.1] years, mean ± [SD], QRS: 150.8 ± 22.0 ms, LBBB in 19 [79.2%]) in whom a QUAD was deployed in a posterolateral position. VCGs were synthesized from digital ECGs using the Kors matrix. An AHR was defined as a ≥10% ΔLV dP/dtmax.

Results: Intraindividually, the change in LV dP/dtmax across different LV pacing configurations of a QUAD (in relation to AAI pacing) ranged from a minimum of 0.95% to a maximum of 20.5% (7.3 ± 5.8%, mean ± SD). Intraindividually, the ΔQRSarea ranged from 2.8 to 75.7 μVs (27.5 ± 21.2 μVs, mean range ± SD). In regression analyses, ΔQRSarea (area under the curve [AUC] 0.87, 95% confidence intervals [CI]: 0.78–0.97, p<0.0001) was a better predictor of AHR than ΔQRS duration (AUC 0.79, 95% CI: 0.7–0.91, p<0.0001). Using a reduction in QRSarea of 47 μVs, ΔQRSarea predicted AHR with a sensitivity of 87.5% and a specificity of 79.3%. In 19/24 (79%) patients, the LV pacing configuration providing the greatest ΔQRSarea also provided the best AHR (p=0.009).

Conclusion: Changing the LV pacing vector on an ideally deployed QUAD lead is associated with varying AHR to CRT. ΔQRSarea may be useful for LV pacing vector optimization in CRT recipients with a QUAD lead.


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European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr43

Introduction: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the incidence and predictors of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016-2020. Methods: Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate […]

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