Shengjie Wu1, Xueying Chen2, Songjie Wang1, Lei Xu1, Fangyi Xiao1, Zhouqing Huang1, Rujie Zheng1, Limeng Jiang1, Pugazhendhi Vijayaraman3, Parikshit S Sharma4, Lan Su5, Weijian Huang6. 1. Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China. 2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China. 3. Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA. 4. Rush University Medical Center, Chicago, Illinois, USA. 5. Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China. Electronic address: 2512057600@qq.com. 6. Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China. Electronic address: weijianhuang69@126.com.
Abstract
OBJECTIVES: This study sought to assess the predictive value of the proposed electrocardiogram and intracardiac electrogram characteristics for confirmation of left bundle branch (LBB) capture. BACKGROUND: Previously proposed criteria to distinguish left bundle branch pacing (LBBP) and left ventricular septum (LVS) pacing (LVSP) have not been fully validated. METHODS: A His bundle pacing lead, an LBBP lead, and a multielectrode catheter at the LVS were placed. Direct LBB capture was defined as demonstration of retrograde His potential on the His bundle pacing lead and/or anterograde left conduction system potentials on the multielectrode catheter during LBBP. The routinely used parameters-His, LBB potential, time from stimulus to left ventricular activation (Stim-LVAT), and paced QRS morphology during LVSP and LBBP at various depths and outputs were analyzed. RESULTS: Thirty patients (21 non-left bundle branch block [LBBB], 9 LBBB) who demonstrated direct LBB capture using the defined criteria were included. The proportion of paced right bundle branch block was 100% during LBB capture in all patients compared to 23.4% in non-LBBB and 44.4% in LBBB during LVSP. LBB potential was recorded in all patients during intrinsic rhythm (non-LBBB group) or His corrective pacing in LBBB. Paced QRS duration was longer during selective LBBP compared to nonselective LBBP or LVSP only. All patients with characteristics of selective LBBP or abrupt decrease in Stim-LVAT of ≥10 ms demonstrated LBB capture. CONCLUSIONS: Direct LBB capture can be confirmed by recording retrograde His potential and anterograde left conduction system potentials. Abrupt decrease in Stim-LVAT of ≥10 ms and demonstration of selective LBBP could be used as simple criteria to confirm LBB capture.
OBJECTIVES: This study sought to assess the predictive value of the proposed electrocardiogram and intracardiac electrogram characteristics for confirmation of left bundle branch (LBB) capture. BACKGROUND: Previously proposed criteria to distinguish left bundle branch pacing (LBBP) and left ventricular septum (LVS) pacing (LVSP) have not been fully validated. METHODS: A His bundle pacing lead, an LBBP lead, and a multielectrode catheter at the LVS were placed. Direct LBB capture was defined as demonstration of retrograde His potential on the His bundle pacing lead and/or anterograde left conduction system potentials on the multielectrode catheter during LBBP. The routinely used parameters-His, LBB potential, time from stimulus to left ventricular activation (Stim-LVAT), and paced QRS morphology during LVSP and LBBP at various depths and outputs were analyzed. RESULTS: Thirty patients (21 non-left bundle branch block [LBBB], 9 LBBB) who demonstrated direct LBB capture using the defined criteria were included. The proportion of paced right bundle branch block was 100% during LBB capture in all patients compared to 23.4% in non-LBBB and 44.4% in LBBB during LVSP. LBB potential was recorded in all patients during intrinsic rhythm (non-LBBB group) or His corrective pacing in LBBB. Paced QRS duration was longer during selective LBBP compared to nonselective LBBP or LVSP only. All patients with characteristics of selective LBBP or abrupt decrease in Stim-LVAT of ≥10 ms demonstrated LBB capture. CONCLUSIONS: Direct LBB capture can be confirmed by recording retrograde His potential and anterograde left conduction system potentials. Abrupt decrease in Stim-LVAT of ≥10 ms and demonstration of selective LBBP could be used as simple criteria to confirm LBB capture.
Keywords:
His bundle pacing; cardiac resynchronization therapy; criteria; left bundle branch; left bundle branch pacing; left ventricular septal pacing; time from stimulus to left ventricular activation
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