Electrophysiological characteristics and possible mechanism of bipolar pacing in left bundle branch pacing

Wu, Hao; Jiang, Longfu; Shen, Jiabo; Zhang, Lu; Zhong, Jinyan; Zhuo, Shanshan

doi:10.1016/j.hrthm.2022.06.022

Cited by 16 publications

(18 citation statements)

References 13 publications

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“…However, specific lead design and deep septal placement during LBBP made it possible to simultaneously pace the ring and tip electrode to improve ventricular synchrony. The effect of anodal bipolar LBBP on QRSd, interventricular synchrony, and capture thresholds was recently described in two studies (4, 5). Both reported the average pacing threshold leading to aLBBP being below 3V at 0.4 ms (2.7 V in the Lin and 2.5 in the Wu study) and a success rate of 61% (22 of 36 patients) and 87% (65 of 75 patients), respectively.…”

Section: Discussionmentioning

confidence: 93%

Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing

Čurila

Jurák

Prinzen

et al. 2023

Preprint

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Background: Left bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. Methods: In patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: aLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved interventricular dyssynchrony (-9 ms (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. Both aLBBP and HBP caused similar absolute levels of interventricular dyssynchrony (e-DYS -9 ms (-12; -6) vs. 10 ms (7;14); however, local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). Conclusion: Although aLBBP significantly improved interventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.

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Section: Discussionmentioning

confidence: 93%

Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing

Čurila

Jurák

Prinzen

et al. 2023

Preprint

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“…Successful LBBP is defined as follows. LBB capture is characterized by paced QRS morphology of the right bundle branch block (RBBB) pattern and all of the following criteria: (1) differential pacing at 8 and 2 V, producing the shortest and constant V6 R-wave peak time and (2) demonstration of left ventricular septal (LVS) to non-selective LBB capture transition during constant output while advancing the lead and non-selective to SLBB capture during unipolar pacing threshold assessment ( 4 , 11 ). The discrete local ventricular component and isoelectric interval with decrementing output during the EGM recording were used as the golden standard of the SLBB capture ( 3 , 4 , 12 , 13 ).…”

Section: Methodsmentioning

confidence: 99%

High-pass filter settings and the role and mechanism of discrete ventricular electrograms in left bundle branch pacing

Shen

Jiang

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveThe characteristics of discrete intracardiac electrogram (EGM) in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete local ventricular components in an intracardiac EGM and to analyze its possible mechanisms.MethodsThis study included 144 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings (30, 60, 100, and 200 Hz) with a low-pass filter at 500 Hz, and their possible mechanisms were analyzed.ResultsLBBP was successfully achieved in 91.0% (131/144) of patients. SLBBP was achieved in 123 patients. The occurrence rates of discrete local ventricular EGM were 16.7, 33.3, 72.9, and 85.4% for HPF settings of 30, 60, 100, and 200 Hz, respectively. The analysis of discrete EGM detection showed significant differences between the different HPF settings. By using the discrete local ventricular component and isoelectric interval as the SLBB capture golden standard, the results of EGMs revealed that the 30 Hz HPF has a sensitivity of 19% and specificity of 100%. The 60 Hz HPF had a sensitivity of 39% and a specificity of 100%. The 100 Hz HPF had a sensitivity of 85% and a specificity of 100%. The 200 Hz HPF had a sensitivity of 100% and specificity of 100%.ConclusionAn optimal HPF setting of 200 Hz is recommended for discrete local ventricular EGM detection. A discrete local ventricular EGM should exhibit an isoelectric interval. A steep deflection and high-frequency ventricular EGM morphology nearly identify an intrinsic EGM morphology.

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“…LBB capture is characterized by paced QRS morphology of the RBBB pattern and all of the following criteria: (1) differential pacing at 8 and 2 V, producing the shortest and constant V6 R-wave peak time (preferably <75 ms), and (2) demonstration of left ventricular septal (LVS) to non-selective LBB capture transition during constant output and non-selective to selective LBB capture during unipolar pacing threshold assessment. [5, 11]…”

Section: Methodsmentioning

confidence: 99%

High-pass filter settings and possible mechanism of discrete electrograms in left bundle branch pacing

Shen

Jiang

et al. 2022

Preprint

Self Cite

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Objective: The characteristics of discrete intracardiac electrograms in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete ventricular components in an intracardiac electrogram (EGM) and to analyze its possible mechanisms. Methods: This study included 95 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings (30, 60, 100, and 200 Hz) with a low-pass filter at 500 Hz, and their possible mechanisms were analyzed. Results: LBBP was successfully achieved in 92.6% (88/95) of patients. SLBBP was achieved in 80 patients. The occurrence rates of discrete EGM were 18.9%, 40.0%, 74.7%, and 84.2% for HPF settings of 30 Hz, 60 Hz, 100 Hz, and 200 Hz, respectively. The analysis of discrete ECG detection showed significant differences between the different HPF settings. By using the discrete EGM as the SLBB capture golden standard, the results of EGMs revealed that the 30 Hz HPF has a sensitivity of 23% and specificity of 100%. The 60 Hz HPF had a sensitivity of 48% and a specificity of 100%. The 100 Hz HPF had a sensitivity of 89% and a specificity of 100%. The 200 Hz HPF had a sensitivity of 100% and specificity of 100%. Conclusions: An optimal HPF setting of 200 Hz is recommended for discrete electrogram detection. A discrete EGM should exhibit an isoelectric interval. A steep deflection and spinous ventricular EGM morphology nearly identify an intrinsic EGM morphology.

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Electrophysiological characteristics and possible mechanism of bipolar pacing in left bundle branch pacing

Cited by 16 publications

References 13 publications

Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing

Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing

High-pass filter settings and the role and mechanism of discrete ventricular electrograms in left bundle branch pacing

High-pass filter settings and possible mechanism of discrete electrograms in left bundle branch pacing

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