{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T19:24:58Z","timestamp":1777836298497,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"AFP Innovation Fund from the Ontario Ministry of Health"},{"name":"Heart and Stroke Foundation of Ontario Career Award","award":["MC7577"],"award-info":[{"award-number":["MC7577"]}]},{"name":"Heart and Stroke Richard Lewar Centre of Excellence, Canada"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>QRS abnormalities may not be apparent in sinus rhythm in electrically stable cardiomyopathy patients who can have quiescent but highly arrhythmogenic substrate. Here, we test the hypothesis that differential changes in QRS construction during right\u2010ventricular apex pacing (RVP) as opposed to atrial pacing (AP) will identify latent substrate for ventricular arrhythmias (VA) and death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty patients with cardiomyopathy free of VA underwent baseline 114\u2010electrode body\u2010surface electrocardiogram during AP (100\u00a0beats per minute [bpm]) and RVP (100 and 120\u00a0bpm). The filtered\u2010averaged QRS at each electrode was deconstructed into individual intra\u2010QRS and post\u2010QRS ventricular myopotentials (V<jats:sub>MP<\/jats:sub>). The primary outcome was VA or death. Prognostic accuracy of V<jats:sub>MP<\/jats:sub> was validated using V1 to V6 leads in another prospective cohort of 44\u2010cardiomyopathy patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010six patients were eligible for initial analysis. After 5\u00a0\u00b1\u00a02 years of follow\u2010up, eight (31%) patients had VA (VA<jats:sub>Pos<\/jats:sub>) while rest were uneventful (VA<jats:sub>Neg<\/jats:sub>). During AP<jats:sub>100<\/jats:sub>, VA<jats:sub>Pos<\/jats:sub> patients expressed more V<jats:sub>MP<\/jats:sub> than VA<jats:sub>Neg<\/jats:sub> patients (16\u00a0\u00b1\u00a01\u00a0vs 12\u00a0\u00b1\u00a01, <jats:italic>P\u00a0<\/jats:italic>=\u00a00.02). RVP<jats:sub>100<\/jats:sub> and RVP<jats:sub>120<\/jats:sub> in VA<jats:sub>Pos<\/jats:sub> patients introduced an additional 5.5\u00a0\u00b1\u00a00.5 and 6.0\u00a0\u00b1\u00a00.5 V<jats:sub>MP<\/jats:sub> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001\u00a0vs AP<jats:sub>100<\/jats:sub>). The relative change with RVP<jats:sub>120<\/jats:sub> versus AP<jats:sub>100<\/jats:sub> in VA<jats:sub>Neg<\/jats:sub> patients exceeded VA<jats:sub>Pos<\/jats:sub> patients by 1.2\u00a0\u00b1\u00a00.5 V<jats:sub>MP<\/jats:sub> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). Increment in V<jats:sub>MP<\/jats:sub> count of\u00a0&lt;8 in lead\u2010V5 with RVP<jats:sub>120<\/jats:sub> compared to AP<jats:sub>100<\/jats:sub> best predicted VA (area under curve 0.81, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01). In the validation cohort, primary outcome occurred in 13 (33%) patients. Native QRS features and AP<jats:sub>100<\/jats:sub> alone failed to predict primary outcome. Patients with increment in V<jats:sub>MP<\/jats:sub> count of\u00a0&lt;8 in lead\u2010V5 with RVP<jats:sub>120<\/jats:sub> versus AP<jats:sub>100<\/jats:sub> had 7.9\u2010fold increased risk of primary outcome (95% confidence interval 1.01, 61.61; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.049).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cardiomyopathy patients at risk of VA or death perturb the QRS less than low\u2010risk patients with differential pacing. This functional response may be useful to identify arrhythmogenic substrate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13566","type":"journal-article","created":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T06:58:18Z","timestamp":1543993098000},"page":"189-200","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Differential pacing from two sites to diagnose risk of ventricular arrhythmia and death"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7972-5375","authenticated-orcid":false,"given":"Sachin","family":"Nayyar","sequence":"first","affiliation":[{"name":"Peter Munk Cardiac Centre University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawel","family":"Kuklik","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Suszko","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay S.","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre University Health Network  Toronto Ontario 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