Introduction
With biventricular (BiV) pacing, also known as cardiac resynchronization therapy, there are pacing leads in the right atrium, right ventricle, and in the coronary sinus on the surface of left ventricle (sometimes the coronary sinus lead is replaced by an epicardial or endocardial left ventricular lead).
Indications for BiV pacing
Figure 1 Cardiac resynchronization therapy recommendation as per ESC guidelines
ECG features
- large Q wave or QS complex in lead I
- leads V5-V6 also frequently demonstrate a QS complex
- tall R wave in lead V1
ECG 1 Sinus rhythm with biventricular pacing 70/min (large R wave in V1, QS in I and V6).
ECG 2 Atrial fibrillation and biventricular pacing 70/min (large R wave in V1, QS in I and V6) (patient with chronic heart failure after RF ablation of AV node).
References
1) Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, Shinn T, Sutton MS; Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) Trial Investigators. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013 Apr 25;368(17):1585-93. doi: 10.1056/NEJMoa1210356. PMID: 23614585.
2) van Stipdonk A, Wijers S, Meine M, Vernooy K. ECG Patterns In Cardiac Resynchronization Therapy. J Atr Fibrillation. 2015;7(6):1214. Published 2015 Apr 30. doi:10.4022/jafib.1214
3) Dalia T, Amr BS. Pacemaker Indications. [Updated 2020 Aug 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507823/
4) https://www.uptodate.com/contents/ecg-tutorial-pacemakers 5)https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-heart-failure-indications
6) Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE; ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013 Aug;34(29):2281-329. doi: 10.1093/eurheartj/eht150. Epub 2013 Jun 24. PMID: 23801822.
7) https://litfl.com/pacemaker-rhythms-normal-patterns/
Introduction
With biventricular (BiV) pacing, also known as cardiac resynchronization therapy, there are pacing leads in the right atrium, right ventricle, and in the coronary sinus on the surface of left ventricle (sometimes the coronary sinus lead is replaced by an epicardial or endocardial left ventricular lead).
Indications for BiV pacing
Figure 1 Cardiac resynchronization therapy recommendation as per ESC guidelines
ECG features
- large Q wave or QS complex in lead I
- leads V5-V6 also frequently demonstrate a QS complex
- tall R wave in lead V1
ECG 1 Sinus rhythm with biventricular pacing 70/min (large R wave in V1, QS in I and V6).
ECG 2 Atrial fibrillation and biventricular pacing 70/min (large R wave in V1, QS in I and V6) (patient with chronic heart failure after RF ablation of AV node).
References
1) Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, Shinn T, Sutton MS; Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) Trial Investigators. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013 Apr 25;368(17):1585-93. doi: 10.1056/NEJMoa1210356. PMID: 23614585.
2) van Stipdonk A, Wijers S, Meine M, Vernooy K. ECG Patterns In Cardiac Resynchronization Therapy. J Atr Fibrillation. 2015;7(6):1214. Published 2015 Apr 30. doi:10.4022/jafib.1214
3) Dalia T, Amr BS. Pacemaker Indications. [Updated 2020 Aug 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507823/
4) https://www.uptodate.com/contents/ecg-tutorial-pacemakers 5)https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-heart-failure-indications
6) Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE; ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013 Aug;34(29):2281-329. doi: 10.1093/eurheartj/eht150. Epub 2013 Jun 24. PMID: 23801822.
7) https://litfl.com/pacemaker-rhythms-normal-patterns/
