Marek Jastrzębski1, Paweł Moskal1, Karol Curila2, Kamil Fijorek3, Piotr Kukla4, Agnieszka Bednarek1, Grzegorz Kiełbasa1, Adam Bednarski1, Adrian Baranchuk5, Danuta Czarnecka1. 1. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland. 2. Cardiocenter, Department of Cardiology, Third Faculty of Medicine, Charles University, Praque, Czech Republic. 3. Department of Statistics, Cracow University of Economics, Kraków, Poland. 4. Department of Cardiology, H. Klimontowicz Specialistic Hospital, Gorlice, Poland. 5. Heart Rhythm Service, Kingston Health Sciences Center, Kingston, Ontario, Canada.
Abstract
AIMS: Permanent His-bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium-this is described as a non-selective (ns)-HB pacing. It is of clinical importance to confirm HB capture using standard electrocardiogram (ECG). Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. METHODS AND RESULTS: Patients with permanent HB pacing were recruited. Electrocardiograms during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. Electrocardiogram criteria for loss/presence of HB capture were identified. In the validation phase, these criteria and the 'HB ECG algorithm' were tested using a separate, sizable set of ECGs. A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6 were identified as the best features for differentiation. The 'HB ECG algorithm' based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. The criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in Leads I, V1, V4-V6, and the V6 RWPT ≤ 100 ms) presented 100% specificity. CONCLUSION: A novel ECG algorithm for the diagnosis of loss of HB capture and criteria for definitive confirmation of HB capture were formulated and validated. The algorithm might be useful during follow-up and the criteria for definitive confirmation of ns-HB capture offer a simple and reliable ancillary procedural endpoint during HB device implantation. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Permanent His-bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium-this is described as a non-selective (ns)-HB pacing. It is of clinical importance to confirm HB capture using standard electrocardiogram (ECG). Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. METHODS AND RESULTS:Patients with permanent HB pacing were recruited. Electrocardiograms during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. Electrocardiogram criteria for loss/presence of HB capture were identified. In the validation phase, these criteria and the 'HB ECG algorithm' were tested using a separate, sizable set of ECGs. A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6 were identified as the best features for differentiation. The 'HB ECG algorithm' based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. The criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in Leads I, V1, V4-V6, and the V6 RWPT ≤ 100 ms) presented 100% specificity. CONCLUSION: A novel ECG algorithm for the diagnosis of loss of HB capture and criteria for definitive confirmation of HB capture were formulated and validated. The algorithm might be useful during follow-up and the criteria for definitive confirmation of ns-HB capture offer a simple and reliable ancillary procedural endpoint during HB device implantation. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Andres Di Leoni Ferrari; Guilherme Ferreira Gazzoni; Luis Manuel Ley Domingues; Jessica Caroline Feltrin Willes; Gustavo Chiari Cabral; Flavio Vinicius Costa Ferreira; Laura Orlandini Lodi; Gustavo Reis Journal: Arq Bras Cardiol Date: 2022-02 Impact factor: 2.000
Authors: Marek Jastrzębski; Haran Burri; Grzegorz Kiełbasa; Karol Curila; Paweł Moskal; Agnieszka Bednarek; Marek Rajzer; Pugazhendhi Vijayaraman Journal: Europace Date: 2022-01-04 Impact factor: 5.214