Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York.
Heart Rhythm. 2022 Dec;19(12):1984-1992. doi: 10.1016/j.hrthm.2022.07.022. Epub 2022 Aug 3.
Left bundle branch pacing (LBBP) is an emerging physiological pacing modality. How to differentiate LBBP from left ventricular septal pacing (LVSP) remains challenging.
We aimed to develop a new personalized intraoperative criterion to confirm left bundle branch (LBB) capture in patients with or without heart failure (HF).
Patients were enrolled if 12-lead surface electrocardiograms of LBBP, LVSP, temporary His bundle pacing (HBP), and right ventricular septal pacing (RVSP) were recorded during the procedure, with the leads placed in the basal midseptal region. Left ventricular activation time (LVAT) was measured during different pacing modalities. ΔLVAT1 was defined as the difference in LVAT between HBP and LBBP/LVSP. ΔLVAT2 was estimated by the difference in LVAT between RVSP and LBBP/LVSP. ΔLVAT1% and ΔLVAT2% were calculated as the percent reduction of ΔLVAT1 and ΔLVAT2, respectively.
A total of 105 consecutive patients were included, of whom 80 (76.2%) had normal cardiac function (65 LBBP and 15 LVSP) and 25 had HF. Patients with LBBP showed significantly shorter LVAT than did those with LVSP. In patients with normal cardiac function, a cutoff value of ΔLVAT1 > 12.5 ms showed 73.9% sensitivity and 93.3% specificity to confirm LBB capture. In patients with HF, a cutoff value of ΔLVAT1% > 9.8% exhibited great accuracy for LBB capture (sensitivity 92.0%; specificity 92.3%). The optimal value of ΔLVAT2% for differentiating LBBP from LVSP was 21.2%.
Temporary HBP and RVSP can serve as references to confirm LBB capture in an individualized fashion in patients with or without HF.
左束支起搏（LBBP）是一种新兴的生理性起搏方式。如何将 LBBP 与左心室间隔起搏（LVSP）区分开来仍然具有挑战性。
我们旨在为有或没有心力衰竭（HF）的患者制定一种新的个性化术中标准，以确认左束支（LBB）夺获。
如果在手术过程中记录到 LBBP、LVSP、临时希氏束起搏（HBP）和右心室间隔起搏（RVSP）的 12 导联体表心电图，并且在基底部中隔区域放置导联，则将患者纳入研究。在不同起搏模式下测量左心室激活时间（LVAT）。ΔLVAT1 定义为 HBP 与 LBBP/LVSP 之间 LVAT 的差异。ΔLVAT2 通过 RVSP 与 LBBP/LVSP 之间 LVAT 的差异来估计。ΔLVAT1%和ΔLVAT2%分别计算为ΔLVAT1 和ΔLVAT2 的百分比降低。
共纳入 105 例连续患者，其中 80 例（76.2%）心功能正常（65 例 LBBP 和 15 例 LVSP），25 例心力衰竭。LBBP 患者的 LVAT 明显短于 LVSP 患者。在心功能正常的患者中，ΔLVAT1>12.5 ms 的截断值显示 73.9%的敏感性和 93.3%的特异性来确认 LBB 夺获。在心力衰竭患者中，ΔLVAT1%>9.8%的截断值对 LBB 夺获具有很高的准确性（敏感性 92.0%；特异性 92.3%）。区分 LBBP 和 LVSP 的最佳ΔLVAT2%值为 21.2%。
临时 HBP 和 RVSP 可作为参考，以个性化方式在有或没有 HF 的患者中确认 LBB 夺获。
