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Assessment of ventricular electrical heterogeneity in left bundle branch pacing and left ventricular septal pacing by using various electrophysiological methods

JHJ. Rijks, L. Heckman, S. Westra, R. Cornelussen, S. Ghosh, K. Curila, R. Smisek, D. Grieco, E. Bressi, UC. Nguyên, J. Lumens, AMW. van Stipdonk, D. Linz, FW. Prinzen, JGLM. Luermans, K. Vernooy

. 2024 ; 35 (12) : 2282-2292. [pub] 20240923

Language English Country United States

Document type Journal Article, Comparative Study

Persistent link   https://www.medvik.cz/link/bmc25003253

Grant support
Medtronic

INTRODUCTION: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG. METHODS: Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF-ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e-DYS16) from UHF-ECG. RESULTS: Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p < .001), SDAT (p < .001), LVAT (p < .001) and e-DYS16 (p < .001). QRSd was only reduced as compared to RV pacing(p < .001). QRS area was similar during LBBP and normal intrinsic conduction, e-DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. CONCLUSION: Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction.

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$a Rijks, Jesse H J $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands $1 https://orcid.org/0000000151364830
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$a Assessment of ventricular electrical heterogeneity in left bundle branch pacing and left ventricular septal pacing by using various electrophysiological methods / $c JHJ. Rijks, L. Heckman, S. Westra, R. Cornelussen, S. Ghosh, K. Curila, R. Smisek, D. Grieco, E. Bressi, UC. Nguyên, J. Lumens, AMW. van Stipdonk, D. Linz, FW. Prinzen, JGLM. Luermans, K. Vernooy
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$a INTRODUCTION: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG. METHODS: Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF-ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e-DYS16) from UHF-ECG. RESULTS: Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p < .001), SDAT (p < .001), LVAT (p < .001) and e-DYS16 (p < .001). QRSd was only reduced as compared to RV pacing(p < .001). QRS area was similar during LBBP and normal intrinsic conduction, e-DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. CONCLUSION: Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction.
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$a Heckman, Luuk $u Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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$a Westra, Sjoerd $u Department of Cardiology, Radboud University Medical Center (RadboudUMC), Nijmegen, The Netherlands $1 https://orcid.org/0000000301656151
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$a Cornelussen, Richard $u Bakken Research Center, Maastricht, The Netherlands
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$a Ghosh, Subham $u Medtronic, Fridley, Minnesota, United States of America
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$a Curila, Karol $u Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Pregue, Czechia
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$a Smisek, Radovan $u The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
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$a Grieco, Domenico $u Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
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$a Nguyên, Uyên Châu $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands $u Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands $1 https://orcid.org/0000000248362946
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$a Lumens, Joost $u Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands $1 https://orcid.org/0000000181297384
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$a van Stipdonk, Antonius M W $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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$a Linz, Dominik $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands $u Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia $u Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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$a Prinzen, Frits W $u Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands $1 https://orcid.org/0000000189179032
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$a Luermans, Justin G L M $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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$a Vernooy, Kevin $u Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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