Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
Case Western Reserve University, Cleveland, OH, 44106, USA.
J Interv Card Electrophysiol. 2023 Dec;66(9):2041-2046. doi: 10.1007/s10840-023-01541-9. Epub 2023 Apr 4.
Left bundle branch area pacing (LBBAP) is a newer technique to deliver more synchronous left ventricular activation. Several criteria have been proposed, but not fully validated, to confirm LBBAP during implantation of the pacing lead. Spectral analysis has been used to characterize the frequency components of the clinical QRS utilizing the Fourier transform algorithm. We hypothesized that higher frequency content of the paced QRS complex may show predictive value of successful LBBAP.
We evaluated 84 patients with ejection fraction > 50%, who underwent LBB lead placement (n = 42) using ≥ 1 current criteria and right ventricular midseptal (RVsp) lead placement (n = 42) from 2000 to 2022. Time frequency analysis (Matlab) was used to determine the frequency content of the paced QRS complex. The centroid frequency (CF), which is the weighted average QRS frequency, was calculated.
Patients in RVsp group had a longer paced QRS duration (155.6 ± 28.0 vs 127.1 ± 17.2, p < 0.002) compared to the LBBAP group. Of all standard ECG leads, the paced QRS in V2 gave the greatest difference of the CF of the LBBAP group at 8.8 ± 1.6 Hz versus 5.7 ± 0.7 Hz of the RVsp group. This difference was significant by both univariate (p < 0.003) and multivariate (p < 0.010) analysis. Predictive value of the CF for successful LBB pacing in lead V2 was highest with an AUC of 0.98. The sensitivity and specificity were 88.1% and 97.6%, respectively.
Spectral analysis predicts successful LBBAP with higher frequency content when compared to RVsp pacing. Given the limitations to the current criteria to confirm LBBAP, intraprocedural use of frequency content analysis of the paced QRS complex in patients may prove useful at verifying LBB capture if verified by prospective clinical trials.
左束支区域起搏（LBBAP）是一种较新的技术，可实现更同步的左心室激活。已经提出了几种标准，但尚未完全验证，以在起搏导线植入期间确认 LBBAP。频谱分析已用于利用傅里叶变换算法对临床 QRS 的频率分量进行特征描述。我们假设起搏 QRS 复合体的高频含量可能具有成功 LBBAP 的预测价值。
我们评估了 2000 年至 2022 年间接受 LBB 导联放置（n = 42）的 84 例射血分数> 50%的患者，其中使用≥1 个当前标准，以及右心室中隔（RVsp）导联放置（n = 42）。使用时频分析（Matlab）来确定起搏 QRS 复合体的频率内容。计算重心频率（CF），即 QRS 频率的加权平均值。
与 LBBAP 组相比，RVsp 组的起搏 QRS 持续时间更长（155.6 ± 28.0 比 127.1 ± 17.2，p < 0.002）。在所有标准 ECG 导联中，起搏 QRS 在 V2 导联的 CF 差异最大，LBBAP 组为 8.8 ± 1.6 Hz，而 RVsp 组为 5.7 ± 0.7 Hz。这种差异在单变量（p < 0.003）和多变量（p < 0.010）分析中均具有统计学意义。V2 导联 CF 对 LBB 起搏成功的预测价值最高，AUC 为 0.98。敏感性和特异性分别为 88.1%和 97.6%。
与 RVsp 起搏相比，频谱分析预测 LBBAP 时具有更高的频率含量。鉴于目前确认 LBBAP 的标准存在局限性，如果通过前瞻性临床试验得到验证，起搏 QRS 复合体的频率内容分析在患者中的应用可能有助于验证 LBB 捕获。
