Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation

Jastrzębski, Marek; Kiełbasa, Grzegorz; Moskal, P.; Bednarek, Agnieszka; Kusiak, Aleksander; Sondej, Tomasz; Bednarski, Adam; Rajzer, Marek; Vijayaraman, Pugazhendhi

doi:10.1016/j.hrthm.2020.12.019

Cited by 70 publications

(38 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Except for this method, recent documents proposed several methods to monitor lead depth: fulcrum sign, sheath angiography, changes in the QRS notch in V1 lead, pacing from the ring electrode and observing fixation beats (the ectopic beats of qR/rsR’ morphology in V1 lead). [ 34 ] In addition, myocardial damage deserves our attention in LBBP. The recent study [ 35 ] showed the number of attempts at lead position was an independent risk factor related to the myocardial damage, so excessive number of attempts should be avoided.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Liu

Li²,

Wang³

et al. 2021

Medicine

View full text Add to dashboard Cite

Background: Right ventricular pacing (RVP) has been widely accepted as a traditional pacing strategy, but long-term RVP has detrimental impact on ventricular synchrony. However, left bundle branch pacing (LBBP) that evolved from His-bundle pacing could maintain ventricular synchrony and overcome its clinical deficiencies such as difficulty of lead implantation, His bundle damage, and high and unstable thresholds. This analysis aimed to appraise the clinical safety and efficacy of LBBP. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing LBBP and RVP. Results: Seven trials with 451 patients (221 patients underwent LBBP and 230 patients underwent RVP) were included in the analysis. Pooled analyses verified that the paced QRS duration (QRSd) and left ventricular mechanical synchronization parameters of the LBBP capture were similar with the native-conduction mode ( P > .7),but LBBP showed shorter QRS duration (weighted mean difference [WMD]: −33.32; 95% confidence interval [CI], −40.44 to −26.19, P < .001), better left ventricular mechanical synchrony (standard mean differences: −1.5; 95% CI: −1.85 to −1.14, P < .001) compared with RVP. No significant differences in Pacing threshold (WMD: 0.01; 95% CI: −0.08 to 0.09, P < .001), R wave amplitude (WMD: 0.04; 95% CI: −1.12 to 1.19, P = .95) were noted between LBBP and RVP. Ventricular impedance of LBBP was higher than that of RVP originally (WMD: 19.34; 95% CI: 3.13–35.56, P = .02), and there was no difference between the 2 groups after follow-up (WMD: 11.78; 95% CI: −24.48 to 48.04, P = .52). And follow-up pacing threshold of LBBP kept stability (WMD: 0.08; 95% CI: −0.09 to 0.25, P = .36). However, no statistical difference existed in ejection fraction between the 2 groups (WMD: 1.41; 95% CI: −1.72 to 4.54, P = .38). Conclusions: The safety and efficacy of LBBP was firstly verified by meta-analysis to date. LBBP markedly preserve ventricular electrical and mechanical synchrony compared with RVP. Meanwhile, LBBP had stable and excellent pacing parameters. However, LBBP could not be significant difference in ejection fraction between RVP during short- term follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Liu

Li²,

Wang³

et al. 2021

Medicine

View full text Add to dashboard Cite

show abstract

“…It is LVSP if just the left ventricular septal myocardium is captured ( Figure 1D ). Both LVSP and LBBP usually present a paced pseudo right bundle branch block (RBBB) pattern in lead V1 ( 11 ), with the percentage of direct evidence that LBBP captured LBB ranging between 60 and 90% ( 12 – 14 ). Therefore, LBBP described in some previous studies was actually LVSP.…”

Section: Brief Pacing Mechanisms Of Lbbp and Lvspmentioning

confidence: 99%

Which Is More Likely to Achieve Cardiac Synchronization: Left Bundle Branch Pacing or Left Ventricular Septal Pacing?

Zhu

Chang

2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

“…Determining the exact depth within the septum remains difficult, since it is usually not possible to perform ventricular pacing during screwing with conventional connector cables and the exact penetration depth is unclear from just the fluoroscopic images. However, Jastrebski et al [19] has recently shown that the ventricular ectopy that becomes apparent as a result of screwing is present in 96% of the cases and that these so-called fixations beats are identical to the paced QRS morphology. Therefore, these fixation beats can help to identify the depth of the LBBP lead and appearance of the r' morphology can be interpreted as a warning sign that the left side of the interventricular septum is reached.…”

Section: Qrs Morphology In Lbbapmentioning

confidence: 99%

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Heckman

Luermans

Čurila

et al. 2021

JCM

View full text Add to dashboard Cite

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

show abstract

Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation

Cited by 70 publications

References 10 publications

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Which Is More Likely to Achieve Cardiac Synchronization: Left Bundle Branch Pacing or Left Ventricular Septal Pacing?

Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Contact Info

Product

Resources

About