35
ECG considerations Major complications
• The onset of QRS to LV time <90 ms
• Lead I: non-QS or QR
• Intrinsic QRS duration <120 ms or
narrower than optimized pace QRS
duration
• Pericardial effusion/Tamponade
• CS or vascular dissection
• Cardiac arrest
• Sustained ventricular tachyarrhythmia
• Others (PE, stroke, respiratory failure,
etc.)
• For baseline wide QRS, unable to have
paced QRS duration ≤130 ms or QRS
narrowing >20%
• Unable to achieve selective or
nonselective His capture
• Same as in CRT with BiV pacing
• Lead dislodgement
• Reduced battery longevity due to
elevated pacing capture thresholds
• Late rise in thresholds
• Unable to achieve the RBBB
configuration or to have paced QRS
duration ≤130 ms
• Unable to achieve LVAT <74–80 ms
• Same as in CRT with BiV pacing
• Risk of late septal perforation
