| Objective: Cardiac X-ray fluoroscopy has been widely used to guide the placement of the pacemaker, however, the evaluation of 2D echo on right ventricular RV lead location (RV) lead still remained unclear. This study aimed to evaluate the echocardiogram, comparing with the x-ray on the RV lead location according to different QRS duration.Methods: Analysis was done in 60 cases with permanent pacemaker implantation,33 male (the mean age was 65.66±8.36 )and 27 female(the mean age was 64.36±8.79). Atrial ventricular block 25 cases, sick sinus syndrome 31 cases, atrial fibrillation with long R-R interval 4 cases. They are divided into the high right ventricular septum (HRVS) group 20 cases, the low right ventricular septum (LRVS) group 20 cases and right ventricular apex(RVA) group 20 cases through cardiac X-ray fluoroscopy randomly. Then the above patients be redefining through echocardiogram and divided into the above three groups. This paper compares the differences between the results measured by the above two methods for testing the position of the right ventricular pacing. We decided the RV lead location according to the duration of QRS wave, then compared the pacemaker electro-cardiogram by means of the two evaluation methods and comparing the two QRS duration difference. We work out the QRS duration of all patients after pacing by recording 12 lead ECG for assessing the differences between two methods.Results:(1)Different pacing sites under X-ray assessment :The mean QRS duration in right ventricular septum (RVS) group is significantly shorter than the RVA group(0.141±0.009s vs 0.163±0.012s,P<0.05).The mean QRS duration in HRVS group compared with the LRVA group has no significant difference (0.136±0.009s vs 0.149±0.010s,P<0.05).(2)Different pacing sites under echocardiogram evaluation :The mean QRS duration in RVS group is significantly shorter than the RVA group(0.133±0.008s vs 0.161±0.011s,P<0.05).The mean QRS duration in HRVS group compared with the LRVA group has no significant difference (0.134±0.008s vs 0.133±0.011s,P﹥0.05).(3)The two groups of diagnosis of RVS under X-ray and under echocardiogram diagnosis: The former QRS wave duration obviously less than the latter(0.133±0.008s vs 0.141±0.009s,P<0.05). The two groups of diagnosis of RVA under X-ray and under echocardiogram diagnosis :The former QRS duration and the latter,have no significant difference(0.161±0.011s vs. 0.163±0.012s,P>0.05).The QRS wave duration of HRVS diagnosed by X-ray and that diagnosed by echocardiogram have no significant difference(0.136±0.009s vs 0.134±0.008s ,P﹥0.05). The QRS duration of LRVS diagnosed by X-ray is significantly longer than the echocardiogram. (0.149±0.010s vs 0.133±0.011s,P<0.05)(.4)There is a significant difference between the diagnosis of the X-ray and echocardiogram(P<0.05).There are forty cases that is diagnosed by fluoroscopy as the electrode position is in RVS, between these cases, echocardiogram find out seven patients lead site is in RVS, two cases are in right ventricular free wall. The QRS duration of the nine cases are significantly longer than that of the RVS pacing cases diagnosed by two methods(0.163±0.010s vs 0.133±0.008s,P<0.05).Conclusion: There is a significant difference in the diagnosis of RV pacing site between X-ray and echocardiogram. The lead site diagnosed by echocardiogram is obviously better than that of X-ray. It suggests that the wrong diagnosis of the RVS pacing site may contribute to wild pacing QRS duration and it may be one of the reasons that RVS pacing is no better than the RVA pacing... |
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