Physiology-based electrocardiographic criteria for left bundle branch capture
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
33677102
DOI
10.1016/j.hrthm.2021.02.021
PII: S1547-5271(21)00193-4
Knihovny.cz E-resources
- Keywords
- Electrocardiographic criteria, Left bundle branch pacing, Left ventricular activation time, Physiological pacing, R-wave peak time,
- MeSH
- Bundle-Branch Block physiopathology therapy MeSH
- Electrocardiography methods MeSH
- Bundle of His physiology MeSH
- Cardiac Pacing, Artificial methods MeSH
- Humans MeSH
- Heart Conduction System physiopathology MeSH
- Aged MeSH
- Heart Rate physiology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: During left bundle branch (LBB) area pacing, it is important to confirm that capture of the LBB, and not just capture of only adjacent left ventricular (LV) myocardium, has been achieved. OBJECTIVE: The purpose of this study was to establish electrocardiographic (ECG) criteria for LBB capture. We hypothesized that because LBB pacing results in physiological depolarization of the LV, then the native QRS can serve as a reference for diagnosis of LBB capture in the same patient. METHODS: Only patients with evidence of LBB capture (QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. RESULTS: A total of 357 ECGs (124 patients) were analyzed: 118 with native rhythm, 124 with nonselective LBB capture, 69 with selective LBB capture, and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 R-wave peak time (RWPT; measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 88.2%-98.0% and 85.7%-95.4%, respectively. Moreover, 100% specific V6 RWPT cutoff for LBB capture diagnosis in patients with narrow QRS/right bundle branch block was determined to be 74 ms. CONCLUSION: We showed equivalency of LV activation times on ECG during native and paced LBB conduction. Therefore, if V6 RWPT is longer during pacing, this finding is indicative of lack of LBB capture.
References provided by Crossref.org
Left bundle branch area pacing outcomes: the multicentre European MELOS study
The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture
