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Canadian Journal of Cardiology

A continuous pacing and recording technique for differentiating left bundle branch pacing from left ventricular septal pacing

Published:September 13, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.008

      Abstract

      Background

      Left bundle branch (LBB) pacing (LBBP) is a promising approach for achieving near-physiological pacing. However, differentiating LBBP from left ventricular septal endocardial pacing (LVS(e)P) remains a challenge. This study aimed to establish a simple and effective method for differentiating LBBP from LVS(e)P and to evaluate their electrophysiological characteristics.

      Methods

      LBBP, using continuous uninterrupted pacing and real-time monitoring of electrocardiograms along with intracardiac electrograms, was performed in 97 consecutive patients. We evaluated the electrophysiological characteristics observed during LBBP using six modalities: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP1 and 2), LVS(e)P, nonselective LBBP (NSLBBP), and selective LBBP (SLBBP).

      Results

      Of the 97 patients, 87 (89.7%) met the criteria (abrupt change in paced QRS morphology with a transition from Qr to QR/qR in lead V1 and shortening of stimulus to V6 R-wave peak time [stim-V6RWPT] of ≥10 ms with constant output while rather than after lead screwing) for nonselective LBB capture. Selective LBB capture was observed in 82 patients (84.5%). The stim-V6RWPT of NSLBBP and SLBBP were significantly shorter than LVS(e)P (67.1 ± 8.7 ms; 67.0 ± 9.3 ms; 82.1 ± 10.9 ms). Stim-QRSend was the narrowest in IVSP2 (136.6 ± 15.2 ms) instead of NSLBBP (140.0 ± 17.1 ms).

      Conclusions

      The uninterrupted pacing technique for differentiating LBBP from LVS(e)P in the same group of patients is feasible. Electrophysiological evidence from our intrapatient-controlled study shows that LBBP and LVS(e)P differ in ventricular electrical synchronization.

      Keywords

      Abbreviations:

      COI (current of injury), ECG (electrocardiogram), EGM (intracardiac electrogram), IVSP (intraventricular septal pacing), LBB (left bundle branch), LBBP (left bundle branch pacing), LBBAP (left bundle branch area pacing), LV (left ventricular), LVS (left ventricular septum), LVS(e)P (left ventricular septal endocardial pacing), NSLBBP (non-selective left bundle branch pacing), RBB (right bundle branch), RBBB (right bundle branch block), RV (right ventricle), RVS (right ventricular septum), RVSP (right ventricular septal pacing), Stim-V6RWPT (stimulus to V6 R-wave peak time), SLBB (selective left bundle branch), SLBBP (selective left bundle branch pacing), TVA (tricuspid valve annulus), VS (ventricular septum)
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