Author + information
- Omar Issa,
- Ben Hurwitz,
- Jody Ritter,
- Saberio Lo Presti,
- Alfonso Tolentino and
- Mount Sinai
Background: Cardiac resynchronization therapy (CRT) has emerged as a viable and effective treatment option for patients with systolic heart failure and conduction abnormalities. However, there remains a paucity of electrocardiogram (ECG) criteria that can accurately identify a ventricular-paced ECG as a CRT device.
Methods: In this observational study, we screened the first 50 patients who underwent dual chamber-pacemaker implantation and the first 50 patients who underwent CRT device implantation at our institution beginning in January 2011. Five patients who were missing a post-operative ECG were excluded. ECG variables were assessed in the 95 remaining patients of which 45 (47.4%) had dual chamber and 50 (52.6%) had CRT devices.
Results: Patients with CRT devices had a higher frequency of two ventricular spikes and right axis deviation, as well as prominent S deflections in lead 1 and R deflections in lead V1. The most specific single criterion for CRT pacing was the presence of two ventricular spikes (100%), while the most sensitive was an S wave in lead 1 > 1.5mm (70%) (Table 1). The best overall variable for identifying CRT pacing was the sum of the S in lead 1 and R in lead V1 greater then 5 mm which produced a specificity of 96% and a sensitivity of 74% (ROC of 0.85).
Conclusions: A sum of greater then 5 mm between the S amplitude in lead 1 and R amplitude in lead V1 may be an accurate criteria for the identification of a CRT device when ventricular pacing is present on an ECG.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 4
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1278-075
- 2017 American College of Cardiology Foundation