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Journal of cardiovascular electrophysiology
03, 2022;33 (3): 448-457.

Differentiating left bundle branch pacing and left ventricular septal pacing: An algorithm based on intracardiac electrophysiology.

Xing Chen, Zhiyong Qian, Fengwei Zou, Yao Wang, Xinwei Zhang, Yuanhao Qiu, Xiaofeng Hou, Xiaohong Zhou, Pugazhendhi Vijayaraman, Jiangang Zou
Author Information
  1. Xing Chen: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. ORCID
  2. Zhiyong Qian: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. ORCID
  3. Fengwei Zou: Montefiore Medical Center, Bronx, New York, USA.
  4. Yao Wang: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. ORCID
  5. Xinwei Zhang: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  6. Yuanhao Qiu: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  7. Xiaofeng Hou: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  8. Xiaohong Zhou: CRHF Division, Medtronic plc, Mounds View, Minnesota, USA.
  9. Pugazhendhi Vijayaraman: Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA.
  10. Jiangang Zou: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. ORCID
PMID: 34978368 DOI: 10.1111/jce.15350

Abstract

BACKGROUND: Left bundle branch pacing (LBBP) is a new near-physiological pacing modality. Distinguishing left ventricular septal only pacing (LVSP) from nonselective LBBP still needs clarification. This prospective study sought to establish a differentiation algorithm to confirm LBBP.
METHODS AND RESULTS: LBBP was attempted in consecutive patients. If direct LBB capture (LBBP) could not be confirmed, LVSP was considered to have been achieved. Intracardiac left ventricular (LV) activation sequence and activation time were analyzed using coronary sinus (CS) electrogram mapping. Electrophysiological parameters including S-CSmax, S-CSmin, LV lateral wall activation time, ΔLV, and LBB potential were compared between LBBP and LVSP. Stimulated LV activation time (S-LVAT) and stimulated QRS duration (S-QRSd) were also compared between the two groups. Multivariate logistic regression analysis was used to develop a prediction algorithm for LBBP. Of the 43 prospectively enrolled patients, 27 underwent LBBP and 16 underwent LVSP. All LBBP patients showed identical LV activation sequences to their intrinsic rhythm while no LVSP patients maintained their intrinsic sequence. S-CSmax, ΔLV, LV lateral wall activation time, and S-LVAT during LBBP were significantly shorter than those during LVSP. Combining LBB potential with S-LVAT had the largest area under the curve (AUC) of 0.985 for confirming LBBP with a sensitivity of 95.2% and a specificity of 93.7%.
CONCLUSIONS: Compared with LVSP, LBBP preserves a normal LV activation sequence and better electrical synchrony. A combination of LBB potential with S-LVAT can be an effective and practical model to distinguish LBBP from LVSP during implantation in patients with normal LBB activation.

Keywords

electrocardiogram intracardiac electrogram left bundle branch pacing left ventricular septal only pacing mapping

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MeSH Term

Algorithms
Bundle of His
Cardiac Electrophysiology
Cardiac Pacing, Artificial
Electrocardiography
Humans
Prospective Studies
Journal Article Research Support, Non-U.S. Gov't

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