Background: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing. Purpose: This study was sought to determine different ECG patterns in patients with BiV pacing. Methods: Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62.0 ± 13.5 years) with advanced heart failure and baseline left bundle branch block pattern after at least 6-month of uncomplicated CRT. Results: During BiV pacing, 65% of the patients showed a dominant R wave in V1. There was a right axis deviation in 57% in frontal plane. However, a left superior axis emerged in 34% and normal frontal plane axis in 9%. Sequential BiV pacing (73% vs. 58%, P = 0.04) and pacing from posterolateral coronary vein (80% vs. 60%, p = 0.045) were more likely to present with a dominant R wave in V1. In sequential pacing, AV interval was significantly longer in patients with negative complex in V1 than in those with positive complex (124 ± 21 vs. 116 ± 8.0, p = 0.005). A Q/q wave was detected in 85% of patients in lead I and 78% in lead aVL. Conclusions: BiV pacing from lateral coronary venous branches and right ventricular apex characteristically presented with dominant R wave in V1, Q/q wave in leads I and aVL, and right or left superior axis. However, a negative complex in V1, QRS axis in other quadrants, and lack of Q/q wave in leads I and aVL did not necessarily indicate a problem.
A., F., F., J., & M., H. (2018). Electrocardiographic patterns in biventricular pacing delivered by second-generation cardiac resynchronization devices. Indian Pacing and Electrophysiology Journal, 18(1), 13–19. https://doi.org/10.1016/j.ipej.2017.10.007 LK - http://sfx.library.uu.nl/utrecht?sid=EMBASE&issn=09726292&id=doi:10.1016%2Fj.ipej.2017.10.007&atitle=Electrocardiographic+patterns+in+biventricular+pacing+delivered+by+second-generation+cardiac+resynchronization+devices&stitle=Indian+Pacing+Electrophysiol.+J.&title=Indian+Pacing+and+Electrophysiology+Journal&volume=18&issue=1&spage=13&epage=19&aulast=Fazelifar&aufirst=Amirfarjam&auinit=A.&aufull=Fazelifar+A.&coden=IPEJC&isbn=&pages=13-19&date=2018&auinit1=A&auini