Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

Abstract

Background Left bundle branch pacing (LBBP) is a novel near-physiological pacing method that still lacks quantitative criteria to guide the selection of lead-implanted sites to enhance the success likelihood of lead deployments. This study aimed to quantitatively analyze the relationships of LBBP success likelihood to the distribution of lead-implanted sites and the lead-localization-pacing electrocardiographic (ECG) features. Methods All the lead-implanted sites in patients with finally successful LBBP were enrolled for analysis, including successful and failed sites. A novel coordinate system was invented to describe the sites' distribution as longitudinal distance (longit-dist) and lateral distance (lat-dist). Corrected distance parameters were generated to eliminate the cardiac dimension variations. The lead-localization-pacing ECG parameters were also collected, such as paced QRS duration (locat-QRSd), left ventricular activation time (locat-LVAT), LVAT/QRSd ratio (locat-LVAT/QRSd), and QRS directions. Results A total of 94 patients with 105 successful sites and 93 failed sites were enrolled. Longit-dist and corrected longitdist of successful sites were significantly longer, while locat-QRSd and locat-LVAT were shorter and locat-LVAT/QRSd was lower than failed sites. There was a positive dose-response relationship between LBBP success likelihood and corrected longit-dist with a cut-off of 26.95 mm, whereas there were negative dose-response relationships of LBBP success likelihood to locat-QRSd, locat-LVAT, and locat-LVAT/QRSd with the cut-offs of 142 ms, 92 ms, and 64.7%, respectively. Downward QRS direction in II/III ECG leads was also associated with successful LBBP. Conclusion Longit-dist, locat-QRSd, locat-LVAT, and locat-LVAT/QRSd were quantitative parameters to guide the selection of lead-implanted sites during LBBP implantation.

Conduction System Pacing: Where Are We Now?

“…They found that successful pacing sites formed a cluster that was more apical in relation to the tricuspid valve than unsuccessful sites, which were more basal. 12 Interestingly, successful sites also correlated with a leftward paced axis, consistent with a more inferior septal pacing site. It is tempting to speculate that preferential activation of the posterior fascicle is more likely to stimulate the late activated posterior lateral ventricular wall, which is a hallmark in typical LBBB, than anterior fascicle activation.…”

Long-term follow-up results of patients with left bundle branch pacing and exploration for potential factors affecting cardiac function

“…Lower ∆Paced QRSd meant the paced QRSd was less prolonged, which correlated to a more stable and synchronized ventricular depolarization during follow-up, which might contribute to the maintenance or the improvement of cardiac function. Corrected longit-dist was proposed as a novel distance parameter for describing the position of LBBP lead ( Lu et al, 2021 ). By eliminating the influence of inter-individual variations of cardiac dimension, corrected longit-dist could more accurately reflect the LBBP lead implanted at the upper or lower region of the IVS.…”

“…We have invented a coordinate system to describe the distribution of the lead-implanted sites quantitatively ( Lu et al, 2021 ). The definitions of contraction line (CL), distance from CL to apex (CL-apex-dist), longitudinal distance (longit-dist), lateral distance (lat-dist), corrected longit-dist, and corrected lat-dist were described in the Supplementary Materials along with the measuring and conversion methods ( Supplementary Table S1 ) and illustrated in Figure 2B .…”

Quantitative analysis reveals influencing factors to facilitate successful anodal-ring capture in left bundle branch pacing

“…The previously described transseptal approach was utilized. 14 , 15 The 3830 lead (1.4 mm, SelectSecure™, Medtronic) was introduced to the RVS via the C315HIS sheath (Medtronic) and screwed to the LBB area. The methodology for lead-implanted site selection was reported in the previous study.…”