First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland.
Cardiocenter, Department of Cardiology, Third Faculty of Medicine, Charles University, Praque, Czech Republic.
Europace. 2019 Dec 1;21(12):1857-1864. doi: 10.1093/europace/euz275.
Permanent His-bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium-this is described as a non-selective (ns)-HB pacing. It is of clinical importance to confirm HB capture using standard electrocardiogram (ECG). Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing.
Patients with permanent HB pacing were recruited. Electrocardiograms during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. Electrocardiogram criteria for loss/presence of HB capture were identified. In the validation phase, these criteria and the 'HB ECG algorithm' were tested using a separate, sizable set of ECGs. A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6 were identified as the best features for differentiation. The 'HB ECG algorithm' based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. The criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in Leads I, V1, V4-V6, and the V6 RWPT ≤ 100 ms) presented 100% specificity.
A novel ECG algorithm for the diagnosis of loss of HB capture and criteria for definitive confirmation of HB capture were formulated and validated. The algorithm might be useful during follow-up and the criteria for definitive confirmation of ns-HB capture offer a simple and reliable ancillary procedural endpoint during HB device implantation.
永久希氏束（HB）起搏通常伴随着相邻右心室（RV）心肌的同时捕获 - 这被描述为非选择性（ns）-HB 起搏。使用标准心电图（ECG）确认 HB 捕获具有临床重要性。我们的目的是确定在 ns-HB 起搏期间 HB 捕获丢失的 ECG 标准。
招募了接受永久性 HB 起搏的患者。获得了 ns-HB 起搏期间和 HB 捕获丢失（仅 RV 捕获）的心电图。确定了用于 HB 捕获丢失/存在的 ECG 标准。在验证阶段，使用单独的大量 ECG 测试了这些标准和“HB ECG 算法”。总共从 226 名接受永久性 HB 起搏装置的患者中获得了 353 份心电图（226 份 ns-HB 和 128 份仅 RV）。左心室导联中的 QRS 切迹/杂音和 V6 导联中的 R 波峰值时间（RWPT）被确定为区分的最佳特征。基于这些特征的“HB ECG 算法”正确分类了 87.1%的病例，敏感性和特异性分别为 93.2%和 83.9%。ns-HB 捕获的明确诊断标准（导联 I、V1、V4-V6 中无 QRS 切迹/杂音，且 V6 RWPT ≤ 100ms）具有 100%的特异性。
提出并验证了用于诊断 HB 捕获丢失的新 ECG 算法和用于明确确认 HB 捕获的标准。该算法可能在随访期间有用，而用于明确确认 ns-HB 捕获的标准则提供了 HB 装置植入过程中简单可靠的辅助程序终点。
