Lateral wall repolarization in standard ECG as a criterion to democratize conduction system pacing
Notice bibliographique
Résumé
Abstract Introduction Conduction System Pacing (CSP) is gaining acceptance when high ventricular pacing burden is expected, and as an alterative to cardiac resynchronization. Criteria to ascertain CSP proper lead placement requires an EP system, not widely available. We hypothesized that when the conduction system is reached and depolarization occurs through normal, fast conducting tissue, repolarization (ST segment and T waves normalization) should be also normal in lateral leads. Methods We extracted all CSP attempted implants form our initial experience. Various accepted criteria for CSP capture were evaluated for each patient, along with two ECG only criteria: any r’/R’ in V1 and T wave polarity in lateral leads, as visual only criteria to CSP capture Results A cohort of 368 consecutive pts was evaluated, 38% were women. Only Medtronic 3830 leads were implanted. Mean age was 77,4 (+/- 9,2 years; range 22-98 y.o.). Implant indication was: Sick sinus 26%, AV block 42%, Abnormal conduction induced cardiomyopathy 26%, AV node ablation 6%. A His was targeted in 7% of pts, and 30% had pre-implant narrow QRS. Leads were directed anterior 25%, posterior 21% and mid-septal in 54% of cases (based on inferior lead polarities). A QRS from the pacing spike of 140ms or narrower was achieved in 79% of implants, a LVAT narrower than 80ms in 73% (narrower than 90ms in 81% of pts and impossible to evaluate in 6% of pts: due to Q-S in V6), and a V6-V1 inter-peak higher than 40ms was achieved in 33% of pts (the criterion was impossible to measure in 35% of pts). An r’/R’ was visible in V1 in 57% of pts, and lateral wall normal repolarization was achieved in 37% at implant. All pts with lateral wall normal repolarization and V6-V1 inter-peak measurable, had values greater than 33ms; and no pts with V6-V1 inter-peak less than 33ms had a normal repolarization in lateral wall. Conclusion CSP implants are feasible using only ECG parameters. Lateral wall repolarization (normalization of ST segment and T waves when the lead arrives at the conduction system) is helpful to differentiate septal capture versus conduction system capture, is easy to evaluate in all patients, and provides another tool to ascertain CSP capture when r’/R’ are not seen (mostly in anterior oriented positions) or V6-V1 inter-peak is impossible to measure (lack of either positive V5-V6 or visible r’/R’ in V1). In our early experience it validates the fact that despite narrow QRS and visible r’/R’ in V1, most of our pts ended up with only with septal capture, and using lateral wall repolarization as an extra tool, would have prompted extra turns to arrive to the conduction system.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».