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Increased QRS duration and dispersion in permanent right ventricular apical pacing

DISCOVERIES (ISSN 2359-7232), 2021, April-June issue

CITATION: 

Chávez-González E, Nodarse-Concepción A, Donoiu I, Rodríguez-González F, Puerta RC, Elizundia JMC. Increased QRS duration and dispersion are associated with mechanical dyssynchrony in patients with permanent right ventricular apical pacing. Discoveries 2021, 9(2): e128. DOI: 10.15190/d.2021.7


Submitted: March 09, 2021; Revised: April 28, 2021; Accepted: May 08, 2021; Published: June 26, 2021; 

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Increased QRS duration and dispersion are associated with mechanical dyssynchrony in patients with permanent right ventricular apical pacing

Elibet Chávez-González (1,*), Arian Nodarse-Concepción (1), Ionuț Donoiu (2,*), Fernando Rodríguez-González (1), Raimundo Carmona Puerta (1), Juan Miguel Cruz Elizundia (1), Gustavo Padrón Peña (1), Ailed Elena Rodríguez-Jiménez (3)

(1) Department of Electrophysiology, Cardiocentro Ernesto Che Guevara, Santa Clara, Villa Clara, Cuba

(2) Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania

(3) Cardiology Service, Camilo Cienfuegos Hospital, Sancti Spíritus, Cuba


*Corresponding authors: Elibet Chávez-González, MD, PhD, Cardiocentro Ernesto Che Guevara, Calle Cuba No. 610 e / Barcelona y Capitán Velazco. Santa Clara, Zip Code: 50200, Villa Clara, Cuba, Email: elibetcg@infomed.sld.cu

Ionuț Donoiu, MD, PhD, Department of Cardiology, University of Medicine and Pharmacy of Craiova, Petru Rareș Street, No. 2, Craiova, 200349, Romania, Email: ionut.donoiu@umfcv.ro

Abstract

Background: Permanent right ventricular apical pacing may have negative effects on ventricular function and contribute to development of heart failure. We aimed to assess intra- and interventricular mechanical dyssynchrony in patients with permanent right ventricular apical pacing, and to establish electrocardiographic markers of dyssynchrony.

Methods: 84 patients (46:38 male:female) who required permanent pacing were studied. Pacing was done from right ventricular apex in all patients. We measured QRS duration and dispersion on standard 12-lead ECG. Intra- and interventricular mechanical dyssynchrony and left ventricular ejection fraction were assessed by transthoracic echocardiography. Patients were followed-up for 24 months. 

Results: Six months after implantation, QRS duration increased from 128.02 ms to 132.40 ms, p≤0.05. At 24 months, QRS dispersion increased from 43.26 ms to 46.13 ms, p≤0.05. Intra- and interventricular dyssynchrony increased and left ventricular ejection fraction decreased during follow-up. A QRS dispersion of 47 ms predicted left ventricular dysfunction and long-term electromechanical dyssynchrony with a sensitivity of 80% and a specificity of 76%. 

Conclusion: In patients with permanent right ventricular apical pacing there is an increased duration and dispersion of QRS related to dyssynchrony and decreased left ventricular ejection fraction. This study shows that QRS dispersion could be a better predictive variable than QRS duration for identifying left ventricular ejection fraction worsening in patients with permanent right ventricular apical pacing. The electrocardiogram is a simple tool for predicting systolic function worsening in these patients and can be used at the bedside for early diagnosis in the absence of clinical symptoms, allowing adjustments of medical treatment to prevent progression of heart failure and improve the patient's quality of life.

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