PROHLÍŽENÍ ABSTRAKTA

COMPARISON OF QRS DURATION MEASUREMENT METHODS IN PATIENTS WITH HIS BUNDLE PACING AND RIGHT VENTRICULAR PACING
Tématický okruh: okruh
Typ: Poster - lékařský , Číslo v programu: 144

Süssenbek O.1, Smíšek R.2, Plešinger F.2, Jurák P.2, Čurila K.3

1 III. int. klinika, FNKV, Praha 10, 2 ÚPT, AVČR, Brno, 3 Kardiologická klinika, Fakultní Nemocnice Královské Vinohrady, Praha


Background
QRS duration (QRSd) is clinically relevant parameter of ventricular dyssynchrony. Its measurement
using different methods lead to different results and it could be also affected by the type of
ventricular activation.
Aim
To compare QRSd measurement methods in patients with right ventricular
myocardial pacing and His bundle pacing.
Methods
12 lead ECGs in 57 patients with bradycardia and with a lead implanted in His bundle region were
analysed. QRSd was measured in 3 ways: 1/ manual QRSd measurement from a paper ECG using an
ECG calliper (QRSd paper), 2/ manual measurement of QRSd using an experimental graphical user
interface (QRSd digital) and 3/ measurement of QRSd by a commercially available software (QRSd sw).
Results
We analysed 169 ECG recordings, of which 57 were spontaneous, 35 selective His bundle
pacing, 55 nonselective His bundle pacing and 22 myocardial pacing. The biggest difference in measured QRSd was found between QRSd digital and QRSd sw (32 ms (Q1 16; Q3 50; p‹0.0001), followed by QRSd digital vs. QRSd paper (26 ms (13;44; ‹0.0001) and QRSd SW vs. QRSd paper (10 ms (4;22; p‹0.0001). When differences in measured QRSd obtained by different
methods were analyses with respect to the underlying ventricular activaton pattern, we found that
differences in QRSd measured by QRSd digital vs. QRSd sw and QRSd digital vs. QRSd paper were during nsHBp
and myocardial capture at least twice as big compared to spontaneous rhythm and sHBp
(33-49 ms vs. 17-21 ms, p ˂ 0.001). The differences in measured QRSd between
QRSd paper and QRSd sw were minimal for all ventricular activation patterns, p=NS.
Conclusion
QRSd is dependent not only on method of its measurement, but also
on type of ventricular activation. Methods routinely used in clinical practise
underestimate QRSd especially in nsHBp and myocardial pacing compared to
its digital measurement.