Marek Jastrzębski1, Grzegorz Kiełbasa2, Karol Curila3, Paweł Moskal2, Agnieszka Bednarek2, Marek Rajzer2, Pugazhendhi Vijayaraman4. 1. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Kraków, Poland. Electronic address: mcjastrz@cyf-kr.edu.pl. 2. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Kraków, Poland. 3. Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. 4. Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania.
Abstract
BACKGROUND: During left bundle branch (LBB) area pacing, it is important to confirm that capture of the LBB, and not just capture of only adjacent left ventricular (LV) myocardium, has been achieved. OBJECTIVE: The purpose of this study was to establish electrocardiographic (ECG) criteria for LBB capture. We hypothesized that because LBB pacing results in physiological depolarization of the LV, then the native QRS can serve as a reference for diagnosis of LBB capture in the same patient. METHODS: Only patients with evidence of LBB capture (QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. RESULTS: A total of 357 ECGs (124 patients) were analyzed: 118 with native rhythm, 124 with nonselective LBB capture, 69 with selective LBB capture, and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 R-wave peak time (RWPT; measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 88.2%-98.0% and 85.7%-95.4%, respectively. Moreover, 100% specific V6 RWPT cutoff for LBB capture diagnosis in patients with narrow QRS/right bundle branch block was determined to be 74 ms. CONCLUSION: We showed equivalency of LV activation times on ECG during native and paced LBB conduction. Therefore, if V6 RWPT is longer during pacing, this finding is indicative of lack of LBB capture.
BACKGROUND: During left bundle branch (LBB) area pacing, it is important to confirm that capture of the LBB, and not just capture of only adjacent left ventricular (LV) myocardium, has been achieved. OBJECTIVE: The purpose of this study was to establish electrocardiographic (ECG) criteria for LBB capture. We hypothesized that because LBB pacing results in physiological depolarization of the LV, then the native QRS can serve as a reference for diagnosis of LBB capture in the same patient. METHODS: Only patients with evidence of LBB capture (QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. RESULTS: A total of 357 ECGs (124 patients) were analyzed: 118 with native rhythm, 124 with nonselective LBB capture, 69 with selective LBB capture, and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 R-wave peak time (RWPT; measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 88.2%-98.0% and 85.7%-95.4%, respectively. Moreover, 100% specific V6 RWPT cutoff for LBB capture diagnosis in patients with narrow QRS/right bundle branch block was determined to be 74 ms. CONCLUSION: We showed equivalency of LV activation times on ECG during native and paced LBB conduction. Therefore, if V6 RWPT is longer during pacing, this finding is indicative of lack of LBB capture.
Authors: L I B Heckman; J G L M Luermans; M Jastrzębski; B Weijs; A M W Van Stipdonk; S Westra; D den Uijl; D Linz; M Mafi-Rad; F W Prinzen; K Vernooy Journal: Neth Heart J Date: 2022-04-05 Impact factor: 2.854
Authors: Andrea Di Marco; Valentina Faga; Jordi Merce; Paolo Dallaglio; Julian Rodriguez; Ignasi Anguera Journal: HeartRhythm Case Rep Date: 2021-10-09
Authors: Karol Curila; Pavel Jurak; Kevin Vernooy; Marek Jastrzebski; Petr Waldauf; Frits Prinzen; Josef Halamek; Marketa Susankova; Lucie Znojilova; Radovan Smisek; Jakub Karch; Filip Plesinger; Pawel Moskal; Luuk Heckman; Jan Mizner; Ivo Viscor; Vlastimil Vondra; Pavel Leinveber; Pavel Osmancik Journal: Front Cardiovasc Med Date: 2021-12-07
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