Korean J Intern Med.  2005 Mar;20(1):15-20. 10.3904/kjim.2005.20.1.15.

The Effects of QRS Duration and Pacing Sites on the Acute Hemodynamic Changes during Right Ventricular Pacing

• Hong YJ
• Yang BR
• Sim DS
• Lim SY
• Lee SH
• Lim JH
• Kim HG
• Park OY
• Kim JH
• Kim W
• Kim NH
• Ahn YK
• Jeong MH
• Cho JG
• Park JC
• Kang JC

• KMID: 1776691
• DOI: http://doi.org/10.3904/kjim.2005.20.1.15

Abstract

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. CONCLUSION: Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.

Keyword

QRS Duration; Pacing; Hemodynamics

MeSH Terms

Blood Pressure/physiology
*Cardiac Pacing, Artificial
Electrophysiologic Techniques, Cardiac
Female
Heart Ventricles/*physiopathology
Hemodynamic Processes/*physiology
Humans
Male
Middle Aged
Tachycardia, Supraventricular/physiopathology/*therapy