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.

• Klíčová slova
• bradycardia pacing, cardiac resynchronization therapy, conduction system pacing, dyssynchrony, left bundle branch area pacing,
• MeSH
• akční potenciály * MeSH
• blokáda Tawarova raménka patofyziologie   terapie   diagnóza   MeSH
• bradykardie patofyziologie   terapie   diagnóza   MeSH
• časové faktory MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční * MeSH
• Hisův svazek * patofyziologie   MeSH
• kardiostimulace umělá * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka * patofyziologie   MeSH
• prediktivní hodnota testů * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční frekvence * MeSH
• srdeční resynchronizační terapie MeSH
• vektorkardiografie * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

• Klíčová slova
• Ablation of atrioventricular node, Conduction system pacing, Delivery sheaths, Left bundle branch area pacing, Persistent left superior vena cava,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

In contrast to left bundle branch pacing, the criteria for left ventricular septal pacing (LVSP) were never validated. LVSP is usually defined as deep septal deployment of the pacing lead with a pseudo-right bundle branch morphology in V1. The case report describes an implant procedure during which this definition of LVSP was fulfilled in four of five pacing locations within the septum, with the shallowest of them present in less than 50% of the septal thickness. The case highlights the need for a more precise definition of LVSP.

• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH