Briongos-Figuero Sem, Estévez Paniagua Álvaro, Sánchez Hernández Ana, Muñoz-Aguilera Roberto
Cardiology Department, Infanta Leonor Hospital, Madrid, Spain.
Front Cardiovasc Med. 2023 Jul 14;10:1217133. doi: 10.3389/fcvm.2023.1217133. eCollection 2023.
QRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in <50% of LBB area pacing (LBBAP) procedures.
We hypothesized that transition from left ventricular septal pacing (LVSP) to LBB pacing (LBBP), when observed during lead penetration into the deep interventricular septum (IVS) with interrupted pacemapping, can suggest LBB capture.
QRS transition during lead screwing-in was defined as shortening of paced V6-R wave peak time (RWPT) by ≥10 ms from LVSP to non-selective LBBP (ns-LBBP) obtained during mid to deep septal lead progression at the same target area, between two consecutive pacing manoeuvres. ECG-based criteria were used to compared LVSP and ns-LBBP morphologies obtained by interrupted pacemapping.
Sixty patients with demonstrated transition from LVSP to ns-LBBP during dynamic manoeuvers were compared to 44 patients with the same transition during lead screwing-in. Average shortening in paced V6-RWPT was similar among study groups (17.3 ± 6.8 ms vs. 18.8 ± 4.9 ms for transition during dynamic manoeuvres and lead screwing-in, respectively; = 0.719). Paced V6-RWPT and aVL-RWPT, V6-V1 interpeak interval and the recently described LBBP score, were also similar for ns-LBBP morphologies in both groups. LVSP morphologies showed longer V6-RWPT and aVL-RWPT, shorter V6-V1 interpeak interval and lower LBBP score punctuation, without differences among the two QRS transition groups. V6-RWPT < 75 ms or V6-V1 interpeak interval > 44 ms criterion was more frequently achieved in ns-LBBP morphologies obtained during lead screwing-in compared to those obtained during dynamic manoeuvres (70.5% vs. 50%, respectively = 0.036).
During LBBAP procedure, QRS transition from LVSP to ns-LBBP can be observed as the lead penetrates deep into the IVS with interrupted pacemapping. Shortening of at least 10 ms in paced V6-RWPT may serve as marker of LBB capture.
动态操作期间的QRS波群移行标准是无创确认左束支（LBB）夺获的金标准，但在<50%的LBB区域起搏（LBBAP）手术中可见。
我们假设，当在将电极导线穿入室间隔深部（IVS）并进行间断起搏标测时观察到从左心室间隔起搏（LVSP）转变为LBB起搏（LBBP），则提示LBB夺获。
在同一目标区域，在电极导线从室间隔中部向深部推进过程中，两次连续起搏操作之间，将电极导线旋入过程中的QRS波群移行定义为起搏V6 - R波峰时间（RWPT）从LVSP缩短至非选择性LBBP（ns - LBBP）≥10毫秒。基于心电图的标准用于比较通过间断起搏标测获得的LVSP和ns - LBBP形态。
将60例在动态操作期间显示从LVSP转变为ns - LBBP的患者与44例在电极导线旋入过程中发生相同转变的患者进行比较。各研究组起搏V6 - RWPT的平均缩短情况相似（动态操作和电极导线旋入过程中转变时分别为17.3±6.8毫秒和18.8±4.9毫秒；P = 0.719）。两组中ns - LBBP形态的起搏V6 - RWPT和aVL - RWPT、V6 - V1峰间间期以及最近描述的LBBP评分也相似。LVSP形态显示V6 - RWPT和aVL - RWPT更长，V6 - V1峰间间期更短，LBBP评分更低，两个QRS波群移行组之间无差异。与动态操作期间获得的ns - LBBP形态相比，电极导线旋入过程中获得的ns - LBBP形态更频繁地达到V6 - RWPT < 75毫秒或V6 - V1峰间间期> 44毫秒的标准（分别为70.5%和50%，P = 0.036）。
在LBBAP手术中，当电极导线通过间断起搏标测深入IVS时，可观察到QRS波群从LVSP转变为ns - LBBP。起搏V6 - RWPT至少缩短10毫秒可作为LBB夺获的标志。
