Physiology-based electrocardiographic criteria for left bundle branch capture

Jastrzębski, Marek; Kiełbasa, Grzegorz; Čurila, Karol; Moskal, P.; Bednarek, Agnieszka; Rajzer, Marek; Vijayaraman, Pugazhendhi

doi:10.1016/j.hrthm.2021.02.021

Cited by 142 publications

(175 citation statements)

References 8 publications

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“…Such an approach was already proposed and validated for the diagnosis of left bundle branch capture during deep septal pacing. 3 In the current study, we aimed to validate the above hypothesis in the setting of HB pacing. Specifically, we hypothesized that during HB All rights reserved.…”

Section: Introductionmentioning

confidence: 91%

“…The results of the present study fully corroborate the above reasoning, adding to the previously published data that physiological LV activation times are the hallmarks of physiological pacing. 2,3 We believe that longer LV activation times could be mechanistically interpreted as the degree of deviation from physiology during pacing.…”

Section: Physiological Perspectivementioning

confidence: 99%

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Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

Jastrzębski

Moskal

Kukla³

et al. 2021

Preprint

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Aims: During non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction. Methods: Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. Results: A total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (+/-9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. Conclusion: We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

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Section: Introductionmentioning

confidence: 91%

Section: Physiological Perspectivementioning

confidence: 99%

Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

Jastrzębski

Moskal

Kukla³

et al. 2021

Preprint

Self Cite

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“…Meeting physiology-based electrocardiographic criteria, namely paced RWPT in V6 (measured from QRS onset) equals the native RWPT and paced RWPT (measured from the stimulus) equals the LBBP potential to V6. [ 29 ]…”

Section: Left Bundle Branch Pacingmentioning

confidence: 99%

“…The morphology of PVCs changes from wide QRS with QS morphology in lead V1 to narrow QRS with an RBB delay pattern (qR/rSR) as the lead traverses from the right to left side of the septum. Template or fixation beat is defined as a PVC with an RBB delay pattern and a duration of <130 ms.[ 29 – 31 ] Rotations should be stopped immediately on observing a template beat. LBB capture can be confirmed at this site by the aforementioned criteria.…”

Section: Left Bundle Branch Pacing Implantation Techniquesmentioning

confidence: 99%

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How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls

Ponnusamy

Vijayaraman

2021

Card Fail Rev

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Cardiac pacing is the treatment of choice for the management of patients with bradycardia. Although right ventricular apical pacing is the standard therapy, it is associated with an increased risk of pacing-induced cardiomyopathy and heart failure. Physiological pacing using His bundle pacing and left bundle branch pacing has recently evolved as the preferred alternative pacing option. Both His bundle pacing and left bundle branch pacing have also demonstrated significant efficacy in correcting left bundle branch block and achieving cardiac resynchronisation therapy. In this article, we review the implantation tools and techniques to perform conduction system pacing.

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Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction system capture

Zhang

Chen

Zhou

et al. 2023

Clinical Cardiology

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Background Left bundle branch area pacing (LBBAP) includes left bundle branch pacing (LBBP) and left ventricular (LV) septal myocardial pacing (LVSP). Hypothesis The study aimed to assess resynchronization effects and clinical outcomes by LBBAP in heart failure (HF) patients with cardiac resynchronization therapy (CRT) indications. Methods LBBAP was successfully performed in 29 consecutive patients and further classified as the LBBP‐group (N = 15) and LVSP‐group (N = 14) based on the LBBP criteria and novel LV conduction time measurement (LV CT, between LBBAP site and LV pacing (LVP) site). AV‐interval optimized LBBP or LVSP, or LVSP combined with LVP (LVSP‐LVP) was applied. LV electrical and mechanical synchrony and clinical outcomes were assessed. Results All 15 patients in the LBBP‐group received optimized LBBP while 14 patients in the LVSP‐group received either optimized LVSP (5) or LVSP‐LVP (9). The LV CT during LBBP was significantly faster than that during LVP (p < .001), while LV CT during LVSP were similar to LVP (p = .226). The stimulus to peak LV activation time (Stim‐LVAT, 71.2 ± 8.3 ms) and LV mechanical synchrony (TSI‐SD, 35.3 ± 9.5 ms) during LBBP were significantly shorter than those during LVSP (Stim‐LVAT 89.1 ± 19.5 ms, TSI‐SD 49.8 ± 14.4 ms, both p < .05). Following 17(IQR 8) months of follow‐up, the improvement of LVEF (26.0%(IQR 16.0)) in the LBBP‐group was significantly greater than that in the LVSP‐group (6.0%(IQR 20.8), p = .001). Conclusions LV activation in LBBP propagated significantly faster than that of LVSP. LBBP generated superior electrical and mechanical resynchronization and better LVEF improvement over LVSP in HF patients with CRT indications.

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Physiology-based electrocardiographic criteria for left bundle branch capture

Cited by 142 publications

References 8 publications

Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls

Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction system capture

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