The electrocardiogram of ventricular capture during transcutaneous cardiac pacing
Transcutaneous cardiac pacing (TCP) is deeply entwined with the problem of assessing ventricular capture on the electrocardiogram (ECG). We sought clarification of ventricular capture during TCP. We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or impl...
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| Veröffentlicht in: | Journal of electrocardiology 2020-01, Vol.58, p.119-124 |
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| creator | Zagkli, Fani Georgakopoulou, Alexandra Chiladakis, John |
| description | Transcutaneous cardiac pacing (TCP) is deeply entwined with the problem of assessing ventricular capture on the electrocardiogram (ECG). We sought clarification of ventricular capture during TCP.
We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or implantable cardioverter-defibrillator implantation. The cohort was stratified by structural heart disease (SHD) status and presence of narrow or wide QRS during spontaneous heart rhythm. We compared 12-lead ECG data at baseline (48 ± 7 beats/min) with those of TCP as well as of transvenous pacing (TVP) at a similar increased heart rate (76 ± 9 beats/min) to ensure constant ventricular capture. The QT interval was corrected for heart rate (QTc) using Bazett's method as well as by the Hodge's and Rautaharju's formulae depending on the presence of narrow or wide QRS at baseline. Electromechanical coupling was assessed by noninvasive arterial pressure measurement.
TCP (median 80 mA) produced a QRS pattern resembling left bundle branch block. Overall, both TCP and TVP induced significant QRS and QTc prolongations when compared with baseline measures (p |
| doi_str_mv | 10.1016/j.jelectrocard.2019.12.002 |
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We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or implantable cardioverter-defibrillator implantation. The cohort was stratified by structural heart disease (SHD) status and presence of narrow or wide QRS during spontaneous heart rhythm. We compared 12-lead ECG data at baseline (48 ± 7 beats/min) with those of TCP as well as of transvenous pacing (TVP) at a similar increased heart rate (76 ± 9 beats/min) to ensure constant ventricular capture. The QT interval was corrected for heart rate (QTc) using Bazett's method as well as by the Hodge's and Rautaharju's formulae depending on the presence of narrow or wide QRS at baseline. Electromechanical coupling was assessed by noninvasive arterial pressure measurement.
TCP (median 80 mA) produced a QRS pattern resembling left bundle branch block. Overall, both TCP and TVP induced significant QRS and QTc prolongations when compared with baseline measures (p < 0.001). TCP created narrower QRS than TVP in those patients with SHD and narrow QRS (p < 0.006). There was no significant QTc duration difference between TCP and TVP. Mean arterial pressure underwent similar significant decrease following either TCP or TVP over baseline (p < 0.001), without difference between the two pacing approaches in any patient group.
TCP is associated with similar ECG and hemodynamic responses to those of TVP, regardless of the presence of SHD.
•Ventricular capture is necessary to effective trancutaneous cardiac pacing (TCP).•TCP is safe, feasible and efficacious in patients with or without apparent structural heart disease.•Ventricular capture in TCP illustrates a QRS pattern resembling left bundle branch block with comparable QRS and QTc prolongations to transvenous pacing at a similar heart rate.</description><identifier>ISSN: 0022-0736</identifier><identifier>EISSN: 1532-8430</identifier><identifier>DOI: 10.1016/j.jelectrocard.2019.12.002</identifier><identifier>PMID: 31838311</identifier><language>eng</language><publisher>PHILADELPHIA: Elsevier Inc</publisher><subject>Cardiac & Cardiovascular Systems ; Cardiac arrhythmia ; Cardiovascular disease ; Cardiovascular System & Cardiology ; Electrocardiogram ; Electrocardiography ; Heart attacks ; Heart failure ; Life Sciences & Biomedicine ; Science & Technology ; Transcutaneous cardiac pacing ; Ventricular capture</subject><ispartof>Journal of electrocardiology, 2020-01, Vol.58, p.119-124</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jan/Feb 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>4</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000515210900025</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c408t-aaf2aabf673bfe2c14e4c820104fbf4e5c5d56be098d7551095ce9d738c42fdd3</citedby><cites>FETCH-LOGICAL-c408t-aaf2aabf673bfe2c14e4c820104fbf4e5c5d56be098d7551095ce9d738c42fdd3</cites><orcidid>0000-0002-4375-0261</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jelectrocard.2019.12.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,28253,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31838311$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zagkli, Fani</creatorcontrib><creatorcontrib>Georgakopoulou, Alexandra</creatorcontrib><creatorcontrib>Chiladakis, John</creatorcontrib><title>The electrocardiogram of ventricular capture during transcutaneous cardiac pacing</title><title>Journal of electrocardiology</title><addtitle>J ELECTROCARDIOL</addtitle><addtitle>J Electrocardiol</addtitle><description>Transcutaneous cardiac pacing (TCP) is deeply entwined with the problem of assessing ventricular capture on the electrocardiogram (ECG). We sought clarification of ventricular capture during TCP.
We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or implantable cardioverter-defibrillator implantation. The cohort was stratified by structural heart disease (SHD) status and presence of narrow or wide QRS during spontaneous heart rhythm. We compared 12-lead ECG data at baseline (48 ± 7 beats/min) with those of TCP as well as of transvenous pacing (TVP) at a similar increased heart rate (76 ± 9 beats/min) to ensure constant ventricular capture. The QT interval was corrected for heart rate (QTc) using Bazett's method as well as by the Hodge's and Rautaharju's formulae depending on the presence of narrow or wide QRS at baseline. Electromechanical coupling was assessed by noninvasive arterial pressure measurement.
TCP (median 80 mA) produced a QRS pattern resembling left bundle branch block. Overall, both TCP and TVP induced significant QRS and QTc prolongations when compared with baseline measures (p < 0.001). TCP created narrower QRS than TVP in those patients with SHD and narrow QRS (p < 0.006). There was no significant QTc duration difference between TCP and TVP. Mean arterial pressure underwent similar significant decrease following either TCP or TVP over baseline (p < 0.001), without difference between the two pacing approaches in any patient group.
TCP is associated with similar ECG and hemodynamic responses to those of TVP, regardless of the presence of SHD.
•Ventricular capture is necessary to effective trancutaneous cardiac pacing (TCP).•TCP is safe, feasible and efficacious in patients with or without apparent structural heart disease.•Ventricular capture in TCP illustrates a QRS pattern resembling left bundle branch block with comparable QRS and QTc prolongations to transvenous pacing at a similar heart rate.</description><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular System & Cardiology</subject><subject>Electrocardiogram</subject><subject>Electrocardiography</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Life Sciences & Biomedicine</subject><subject>Science & Technology</subject><subject>Transcutaneous cardiac pacing</subject><subject>Ventricular capture</subject><issn>0022-0736</issn><issn>1532-8430</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><recordid>eNqNkUtv1DAUhS1ERYfCX0ARbCqhBD_iScIOTXlUqoSQytpy7OviKBMPfhTx77klQ1Wx6sqW_Z3rc44Jec1owyjbvpuaCWYwOQajo204ZUPDeEMpf0I2TApe962gT8kGT3hNO7E9Jc9TmiilA-_4M3IqWC96wdiGfLv-AdWDaT7cRL2vgqtuYcnRmzLrWBl9yCVCZUv0y02Vo16SKVkvEEqq_uq0qQ7a4O0LcuL0nODlcT0j3z99vN59qa--fr7cfbiqTUv7XGvtuNaj23ZidMANa6E1PWahrRtdC9JIK7cj0KG3nZSMDtLAYDvRm5Y7a8UZOV_nHmL4WSBltffJwDyvrhQXHOGWygHRN_-hUyhxQXdIdYwJztsOqfcrZWJIKYJTh-j3Ov5WjKq74tWkHhav7opXjCusGcWvjk-UcQ_2XvqvaQT6FfgFY3DJeFgM3GP4NZJJjilxx-XOZ519WHahLBmlbx8vRfpipQHLv_UQ1VFhfUTvygb_mEB_AM4hvQM</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Zagkli, Fani</creator><creator>Georgakopoulou, Alexandra</creator><creator>Chiladakis, John</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Science Ltd</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4375-0261</orcidid></search><sort><creationdate>202001</creationdate><title>The electrocardiogram of ventricular capture during transcutaneous cardiac pacing</title><author>Zagkli, Fani ; Georgakopoulou, Alexandra ; Chiladakis, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-aaf2aabf673bfe2c14e4c820104fbf4e5c5d56be098d7551095ce9d738c42fdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular System & Cardiology</topic><topic>Electrocardiogram</topic><topic>Electrocardiography</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Life Sciences & Biomedicine</topic><topic>Science & Technology</topic><topic>Transcutaneous cardiac pacing</topic><topic>Ventricular capture</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zagkli, Fani</creatorcontrib><creatorcontrib>Georgakopoulou, Alexandra</creatorcontrib><creatorcontrib>Chiladakis, John</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of electrocardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zagkli, Fani</au><au>Georgakopoulou, Alexandra</au><au>Chiladakis, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The electrocardiogram of ventricular capture during transcutaneous cardiac pacing</atitle><jtitle>Journal of electrocardiology</jtitle><stitle>J ELECTROCARDIOL</stitle><addtitle>J Electrocardiol</addtitle><date>2020-01</date><risdate>2020</risdate><volume>58</volume><spage>119</spage><epage>124</epage><pages>119-124</pages><issn>0022-0736</issn><eissn>1532-8430</eissn><abstract>Transcutaneous cardiac pacing (TCP) is deeply entwined with the problem of assessing ventricular capture on the electrocardiogram (ECG). We sought clarification of ventricular capture during TCP.
We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or implantable cardioverter-defibrillator implantation. The cohort was stratified by structural heart disease (SHD) status and presence of narrow or wide QRS during spontaneous heart rhythm. We compared 12-lead ECG data at baseline (48 ± 7 beats/min) with those of TCP as well as of transvenous pacing (TVP) at a similar increased heart rate (76 ± 9 beats/min) to ensure constant ventricular capture. The QT interval was corrected for heart rate (QTc) using Bazett's method as well as by the Hodge's and Rautaharju's formulae depending on the presence of narrow or wide QRS at baseline. Electromechanical coupling was assessed by noninvasive arterial pressure measurement.
TCP (median 80 mA) produced a QRS pattern resembling left bundle branch block. Overall, both TCP and TVP induced significant QRS and QTc prolongations when compared with baseline measures (p < 0.001). TCP created narrower QRS than TVP in those patients with SHD and narrow QRS (p < 0.006). There was no significant QTc duration difference between TCP and TVP. Mean arterial pressure underwent similar significant decrease following either TCP or TVP over baseline (p < 0.001), without difference between the two pacing approaches in any patient group.
TCP is associated with similar ECG and hemodynamic responses to those of TVP, regardless of the presence of SHD.
•Ventricular capture is necessary to effective trancutaneous cardiac pacing (TCP).•TCP is safe, feasible and efficacious in patients with or without apparent structural heart disease.•Ventricular capture in TCP illustrates a QRS pattern resembling left bundle branch block with comparable QRS and QTc prolongations to transvenous pacing at a similar heart rate.</abstract><cop>PHILADELPHIA</cop><pub>Elsevier Inc</pub><pmid>31838311</pmid><doi>10.1016/j.jelectrocard.2019.12.002</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4375-0261</orcidid></addata></record> |
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| subjects | Cardiac & Cardiovascular Systems Cardiac arrhythmia Cardiovascular disease Cardiovascular System & Cardiology Electrocardiogram Electrocardiography Heart attacks Heart failure Life Sciences & Biomedicine Science & Technology Transcutaneous cardiac pacing Ventricular capture |
| title | The electrocardiogram of ventricular capture during transcutaneous cardiac pacing |
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