ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Implementation of lead V8 as a simple non-invasive tool to improve patient selection in cardiac resynchronization therapy and guide left ventricular lead placement.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Non-invasive assessment of left atrial activation using lead V8 during Bachmann bundle pacing.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- The Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non-Invasively With the Implementation of Lead V8.Journal of cardiovascular electrophysiology · 2026Article
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13 authors.
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Abstract
aimsCardiac resynchronization therapy (CRT) improves outcomes in heart failure patients with electrical dyssynchrony. The QLV interval, a marker of delayed left ventricular (LV) activation, independently predicts CRT response. This study aimed to determine whether activation time measured in surface ECG lead V8 reflects posterolateral LV delay by correlating with the QLV interval during biventricular (BiV) CRT implantation. METHODS AND
resultsConsecutive patients with wide QRS (non-RBBB) undergoing BiV-CRT or generator change were prospectively enrolled. Surface ECGs were recorded with the V5 electrode repositioned to the V8 location. Local wavefront activation was determined using the steepest negative downslope of the precordial leads, referred to as the negative derivative activation time (NDAT). The LV lead was connected to the EP recording system, and NDAT and QLV measurements were obtained. Forty-three patients were included. The NDAT in V8 strongly correlated with the QLV interval (r = 0.895; mean difference 1 ± 11 ms) across both LBBB and IVCD patterns. In contrast, NDAT in V6 showed weaker correlation (r = 0.592; mean difference 21 ± 24 ms). During LV-only pacing, a QS morphology in V8 consistently indicated posterolateral lead placement. More anterior/apical lead positions showed larger QLV-negative derivative activation time (NDAT) V8 differences and non-QS morphologies, indicating suboptimal positioning.
conclusionNDAT in lead V8 is a non-invasive marker of delayed activation in the posterolateral LV, outperforming V6 in identifying late activation. When combined with LV-paced QRS morphology, V8 facilitates accurate lead localization without additional tools. These findings may support the use of lead V8 to refine patient selection and optimize CRT delivery.
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