The Analysis Of Body Surface Electrocardiogram Of Different Coronary Sinus Pacing Sites

Objective:To analyze the 12-lead body surface electrocardiogram of different coronary sinus pacing sites. To investigate the effect of multiple coronary sinus pacing on the atrial activation time, atrialventricular conduction and ventricular activation time through analyzing the characteristics of P wave duration maximum, PR interval and QRS duration. To compare the success rate of different pacing sites. Seeking the evidence for the replacement of auricle of right atrium,biatrial or multiple atrial pacing by coronary sinus pacing.Methods : Analysis was done in 52 cases with paroxysmal supraventricular tachycardia for successful radiofrequency catheter ablation(RFCA), 24 male and 28 female, the mean age 47.51±13.51 years. After RFCA, coronary sinus electrode was retained. Recording the 12-lead body surface ECG when the heart rate returned to the basal state. According to the sites of coronary sinus electrode, there were 3 groups: distal coronary sinus pacing (CSd), middle coronary sinus pacing(CSm), proximal coronary sinus pacing (CSp).The pacing rate was 10～20bpm higher than the basal state. The 12-lead body surface electrocardiogram was recorded after different sites pacing during. Each group was measured and compared with the P wave duration maximum, PR interval, QRS duration. The success rate of pacing in each group was calculated. Then analyzed the data statistically.Results:①The Median and Interquartile range of P wave duration maximum during sinus rhythm before pacing was 113.00ms, 30.00ms;CSd group was 63.20ms, 3.00ms;CSm group was 65.30ms, 2.00ms;CSp group was 63.80ms, 3.00ms. Compared with sinus rhythm before pacing, the P wave duration maximum was significantly shorter in the three groups of CSd, CSm and CSp(P<0.01). The P wave duration maximum had no significant difference among the three groups of CSd, CSm and CSp (P>0.05).②The Median and Interquartile range of PR interval during sinus rhythm before pacing was 150.00ms, 40.00ms;CSd group was 210.00ms, 36.50ms;CSm group was 190.00ms, 34.00ms;CSp group was 190.00ms, 41.30ms. Compared with sinus rhythm before pacing, the PR interval was significantly prolonged in the three groups of CSd, CSm and CSp (P<0.01). Compared with CSm and CSp groups, the PR interval of CSd group was significantly longer (P <0.01). There were no significant difference between the group of CSp and CSm (P>0.05).③The Median and Interquartile range of QRS duration during sinus rhythm before pacing was 101.50ms, 12.50ms;CSd group was 107.50ms, 28.50ms;CSm group was 100.00ms, 18.50ms;CSp group was 100.00ms, 20.00ms;Compared with sinus rhythm before pacing, the QRS duration of the three groups of CSd, CSm and CSp has no significant difference(P>0.05).④The success rate of pacing in CSd group was 71.15%, CSm group was 88.46%, CSp group was 67.31%, difference between the three groups were significant (P<0.01). The success rate of CSm group was higher than CSd group and CSp group (P<0.05). There was no significant difference between the group of CSd and CSp (P>0.05).Conclusion:Pacing in CSd, CSm and CSp can reduce the P wave duration maximum and atrial activation time. Pacing in CSd, CSm and CSp can increase the PR interval, make the atrialventricular conduction time longer. Pacing in CSd, CSm and CSp had no effect on QRS duration and ventricular activation time. Compared with CSd and CSp, the success rate of pacing in CSm was the highest. So CSm was the best pacing site in coronary sinus.