First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
Heart Rhythm. 2021 Apr;18(4):562-569. doi: 10.1016/j.hrthm.2020.12.019. Epub 2020 Dec 25.
One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.
The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsR' morphology in lead V (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats-guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.
Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.
左束支（LBB）起搏的挑战之一是将起搏导线放置在间隔足够深的位置以到达 LBB 区域，但又不能太深以避免穿孔。
本研究旨在探讨在导线固定过程中，导联 V 出现 qR/rsR'形态的异位搏动（固定搏动）是否可以预测是否已达到所需的间隔内导线深度，而缺乏固定搏动则表明位置过浅，需要更多的导线旋转。
回顾性分析连续接受 LBB 起搏装置植入的患者，并前瞻性分析每次导线旋转过程中固定搏动的发生情况。我们比较了在达到 LBB 区域深度之前和在中间/不成功位置之前的每个导线旋转事件中固定搏动的存在情况。
共分析了 339 例患者和 1278 次导线旋转事件。在回顾性阶段，339 个最终导线位置中有 327 个和 939 个中间导线位置中有 9 个观察到固定搏动（P <.001）。固定搏动作为到达 LBB 区域标志物的敏感性、特异性、阳性预测值和阴性预测值分别为 96.4%、97.3%、97.3%和 96.5%。在前瞻性、基于固定搏动引导的植入阶段，所有患者均观察到固定搏动，且仅在 LBB 捕获深度观察到。
在深部间隔内导线放置过程中监测固定搏动可以促进手术过程，并可能提高导线植入的安全性。
