Biventricular pacing

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
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