Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
JACC Clin Electrophysiol. 2021 Sep;7(9):1166-1177. doi: 10.1016/j.jacep.2021.02.018. Epub 2021 Apr 28.
This study sought to assess the predictive value of the proposed electrocardiogram and intracardiac electrogram characteristics for confirmation of left bundle branch (LBB) capture.
Previously proposed criteria to distinguish left bundle branch pacing (LBBP) and left ventricular septum (LVS) pacing (LVSP) have not been fully validated.
A His bundle pacing lead, an LBBP lead, and a multielectrode catheter at the LVS were placed. Direct LBB capture was defined as demonstration of retrograde His potential on the His bundle pacing lead and/or anterograde left conduction system potentials on the multielectrode catheter during LBBP. The routinely used parameters-His, LBB potential, time from stimulus to peak ventricular activation (Stim-LVAT), and paced QRS morphology during LVSP and LBBP at various depths and outputs were analyzed.
Thirty patients (21 non-left bundle branch block [LBBB], 9 LBBB) who demonstrated direct LBB capture using the defined criteria were included. The proportion of paced right bundle branch block was 100% during LBB capture in all patients compared to 23.4% in non-LBBB and 44.4% in LBBB during LVSP. LBB potential was recorded in all patients during intrinsic rhythm (non-LBBB group) or His corrective pacing in LBBB. Paced QRS duration was longer during selective LBBP compared to nonselective LBBP or LVSP only. All patients with characteristics of selective LBBP or abrupt decrease in Stim-LVAT of ≥10 ms demonstrated LBB capture.
Direct LBB capture can be confirmed by recording retrograde His potential and anterograde left conduction system potentials. Abrupt decrease in Stim-LVAT of ≥10 ms and demonstration of selective LBBP could be used as simple criteria to confirm LBB capture.
本研究旨在评估所提出的心电图和心内电图特征对左束支（LBB）夺获的预测价值。
先前提出的区分左束支起搏（LBBP）和左心室间隔（LVS）起搏（LVSP）的标准尚未得到充分验证。
放置希氏束起搏导联、LBBP 导联和 LVS 的多电极导管。直接 LBB 夺获定义为在 LBBP 时在希氏束起搏导联上显示逆行希氏电位和/或在多电极导管上显示顺行左传导系统电位。分析了在 LBBP 和 LVSP 时各种深度和输出下常规使用的参数-希氏、LBB 电位、刺激至心室激活峰值的时间（Stim-LVAT）和起搏 QRS 形态。
30 例患者（21 例非左束支传导阻滞[LBBB]，9 例 LBBB）根据定义的标准显示直接 LBB 夺获。与非 LBBB 时的 23.4%和 LBBB 时的 44.4%相比，所有患者在 LBB 夺获时均显示 100%的起搏右束支阻滞。在所有患者中，在固有节律（非 LBBB 组）或 LBBB 中的希氏矫正起搏期间均记录到 LBB 电位。与非选择性 LBBP 或仅 LVSP 相比，选择性 LBBP 时起搏 QRS 持续时间更长。所有具有选择性 LBBP 或 Stim-LVAT 突然下降≥10ms 的特征的患者均显示 LBB 夺获。
通过记录逆行希氏电位和顺行左传导系统电位可以确认直接 LBB 夺获。Stim-LVAT 的突然下降≥10ms 和选择性 LBBP 的显示可以作为确认 LBB 夺获的简单标准。
