Recording an isoelectric interval as an endpoint of left bundle branch pacing with continuous paced intracardiac electrogram monitoring

Abstract

Background:The present study aimed to evaluate the feasibility and safety of the novel left bundle branch pacing (LBBP) procedure that uses isoelectric interval as an endpoint for lead implantation.Methods: A total of 41 patients with indications for pacing were enrolled. All patients underwent a novel LBBP procedure guided by recording an isoelectric interval as an endpoint for lead implantation. The procedural details and electrophysiological characteristics were then analyzed.Results: A total of 38/41 (92.7%) cases were confirmed of left bundle branch (LBB) capture. An isoelectric interval was observed in 36/41 cases (87.8%). A total of 36/41 (87.8%) cases with LBB potential were observed. The mean unipolar LBBP threshold at the implant was 0.5 ± 0.2 V. The mean sensed amplitude of the R wave and the pacing impedance at the implant were 12.9 ± 5.0 mV and 723.5 ± 117.1 Ω. During the final threshold testing, a transition from non-selective to selective LBBP (S-LBBP) was demonstrated in 26 patients. A transition from non-selective LBBP (NS-LBBP) to left ventricular septal myocardial capture was observed in 12 patients. Conclusion:Using an isoelectric interval as an endpoint to guide the LBBP was feasible in a high proportion of captured LBB cases.

Right subclavian vein approach for selective left bundle branch pacing: A case report

“…During the screwring procedure, the tail of pacing lead was always connected with the John Jiang's connecting cable. The recent research by our team has showed that the equipment might be more effective and convenient to monitor ECG, EGM, and impedance in real time to avoid perforation and to guide effective endpoint without the need to stop pacing (Shen, Jiang, Cai, et al, 2022; Shen, Jiang, Jiang, et al, 2022; Wu et al, 2022), so when the vascular pathway was established, TVA angiography was performed, and sheath was placed in what we thought the ideal position, the screwing of lead started. During the process, a narrow premature beat which shows right bundle branch conduction delay (RBBD) with an rSR pattern in V1 occurred (Figure 2).…”

“…At this time, the lead screwing was stopped and the impedance was monitored frequently Immediately, an isoelectric interval on the ECG and an S‐V interval on the EGM were recorded (Figure 2). In our recent study, we proposed a novel LBBP procedure that used isoelectric interval as an endpoint for lead implantation (Wu et al, 2022), so, based on our experience, the LBB was captured and the whole process lasted about 57 s and was successful at one time.…”

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

“…This retrospective observational study enrolled consecutive patients who underwent successful permanent pacemaker implantation. LBBP uses John Jiang's connecting cable (Xinwell Medical Technology Co., Ltd., Ningbo, Zhejiang, China) for the continuous pacing and recording technique, and the procedure has been described by us elsewhere (7)(8)(9)(10). The study protocol was approved by the Ethics Committee of the Hwa Mei Hospital, Ningbo, China.…”

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

“…LBBP uses the continuous pacing and recording technique, and the procedure has been described by us in detail elsewhere. [8][9][10] The study protocol was approved by the Ethics Committee of the Hwa Mei Hospital, Ningbo, China. Written informed consent was obtained from all patients.…”