Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG). Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP -16 ms (-21; -11), than nsLBBp -24 ms (-28; -20) and sLBBp -31 ms (-36; -25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference -9 ms (-16; -1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis. Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

Cardiocenter 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady Prague Czechia

Department of Anesthesia and Intensive Care Charles University University Hospital Kralovske Vinohrady Prague Czechia

Department of Biomedical Engineering Faculty of Electrical Engineering and Communication Brno University of Technology Brno Czechia

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Maastricht Netherlands

Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Maastricht Netherlands

International Clinical Research Center St Anne's University Hospital Brno Czechia

The Czech Academy of Sciences Institute of Scientific Instruments Brno Czechia

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Huang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P, et al. . A beginner's guide to permanent left bundle branch pacing. Heart Rhythm. (2019) 16:1791–6. 10.1016/j.hrthm.2019.06.016 PubMed DOI

Heckman LIB, Luermans JGLM, Curila K, Van Stipdonk AMW, Westra S, Smisek R, et al. . Comparing ventricular synchrony in left bundle branch and left ventricular septal pacing in pacemaker patients. J Clin Med. (2021) 10:822. 10.3390/jcm10040822 PubMed DOI PMC

Jastrzebski M, Moskal P. Reaching the left bundle branch pacing area within 36 heartbeats. Kardiol Pol. (2021) 79:587–8. 10.33963/KP.15914 PubMed DOI

Curila K, Jurak P, Jastrzebski M, Prinzen F, Waldauf P, Halamek J, et al. . The left bundle branch pacing compared to left ventricular septal myocardial pacing increases interventricular dyssynchrony but accelerates left ventricular lateral wall depolarization. Heart Rhythm. (2021) 18:1281–9. 10.1016/j.hrthm.2021.04.025 PubMed DOI

Wu S, Sharma PS, Huang W. Novel left ventricular cardiac synchronization: left ventricular septal pacing or left bundle branch pacing? Europace. (2020) 22(Suppl. 2):ii10–8. 10.1093/europace/euaa297 PubMed DOI

Su L, Wang S, Wu S, Xu L, Huang Z, Chen X, et al. . Long-term safety and feasibility of left bundle branch pacing in a large single-center study. Circ Arrhythm Electrophysiol. (2021) 14:e009261. 10.1161/CIRCEP.120.009261 PubMed DOI

Jurak P, Curila K, Leinveber P, Prinzen FW, Viscor I, Plesinger F, et al. . Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization. J Cardiovasc Electrophysiol. (2020) 31:300–7. 10.1111/jce.14299 PubMed DOI

Huang W, Su L, Wu S, Xu L, Xioa F, Zhou X, et al. . A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. (2017) 33:1736.e1–e3. 10.1016/j.cjca.2017.09.013 PubMed DOI

Jastrzebski M, Keilbasa G, Curila K, Moskal P, Bednarek A, Rajzer M, et al. . Physiology-based electrocardiographic criteria for left bundle branch capture. Heart Rhythm. (2021) 18:935–43. 10.1101/2020.12.24.20248827 PubMed DOI

Curila K, Jurak P, Halamek J, Prinzen F, Waldauf P, Karch J, et al. . Ventricular activation pattern assessment during right ventricular pacing: Ultra-high-frequency ECG study. J Cardiovasc Electrophysiol. (2021) 32:1385–94. 10.1111/jce.14985 PubMed DOI

Beer D, Sharma PS, Subzposh FA, Naperkowski A, Pietrasik GM, Durrm B, et al. . Clinical outcomes of selective versus nonselective his bundle pacing. JACC Clin Electrophysiol. (2019) 5:766–74. 10.1016/j.jacep.2019.04.008 PubMed DOI

Su L, Xu T, Cai M, Xu L, Vijayaraman P, Sharma PS, et al. . Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing. J Cardiovasc Electrophysiol. (2020) 31:834–42. 10.1111/jce.14377 PubMed DOI

Wu S, Chen X, Wang S, Xu L, Xiao F, Huang Z, et al. . Evaluation of the criteria to distinguish left bundle branch pacing from left ventricular septal pacing. JACC Clin Electrophysiol. (2021) 7:1166–77. 10.1016/j.jacep.2021.02.018 PubMed DOI

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