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

Elibet Chávez-González; Arian Nodarse-Concepción; Ionuț Donoiu; Fernando Rodríguez-González; Raimundo Carmona Puerta; Juan Miguel Cruz Elizundia; Gustavo Padrón Peña; Ailed Elena Rodríguez-Jiménez

doi:10.15190/d.2021.7

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

Discoveries (Craiova). 2021 Jun 26;9(2):e128. doi: 10.15190/d.2021.7. eCollection 2021 Apr-Jun.

Authors

Elibet Chávez-González¹, Arian Nodarse-Concepción¹, Ionuț Donoiu², Fernando Rodríguez-González¹, Raimundo Carmona Puerta¹, Juan Miguel Cruz Elizundia¹, Gustavo Padrón Peña¹, Ailed Elena Rodríguez-Jiménez³

Affiliations

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.

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.

Keywords: Cardiac pacing; echocardiography; left ventricular function; ventricular dyssynchrony..