Biventricular pacing


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).


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