基于心电图的左束支内不同起搏部位的定制标准。
Tailored electrocardiographic-based criteria for different pacing locations within the left bundle branch.
机构信息
Cardiology Department, Hospital Infanta Leonor Hospital, Madrid, Spain.
Cardiology Department, Hospital Infanta Leonor Hospital, Madrid, Spain.
出版信息
Heart Rhythm. 2024 Jan;21(1):54-63. doi: 10.1016/j.hrthm.2023.09.015. Epub 2023 Sep 21.
BACKGROUND
Electrocardiographic (ECG)-based criteria are used to confirm left bundle branch (LBB) pacing (LBBP), but current cutoff values have never been validated for different pacing locations.
OBJECTIVE
The purpose of this study was to describe diagnostic performance of V6-R wave peak time (RWPT), V6-V1 interpeak interval, and aVL-RWPT for different pacing sites within the LBB and to determine 100% specific values for each criterion at each pacing location.
METHODS
Consecutive patients with confirmed LBBP were selected. Population was divided into subgroups based on the site of pacing: left bundle trunk pacing (LBTP), left septal fascicular pacing (LSFP), left posterior fascicular pacing (LPFP), and left anterior fascicular pacing (LAFP).
RESULTS
A total of 147 patients with unequivocal LBB capture were analyzed. Left fascicular pacing was more frequently achieved (82.8%) than LBTP (17.2%). Diagnostic performance of V6-RWPT, V6-V1 interpeak interval, and aVL-RWPT for discrimination of LBBP was good in all subgroups. V6-RWPT cutoff values with 100% specificity (SP) for LBBP discrimination were 75 ms in LBTP, 68 ms in LPFP, 81 ms in LAFP, and 79.5 ms in LSFP. V6-V1 interpeak interval cutoff values with 100% SP for LBBP discrimination were 35.5 ms in LBTP, 53.5 ms in LPFP, 41 ms in LAFP, and 46 ms in LSFP. In LAFP, aVL-RWPT cutoff value with 100% SP for LBBP discrimination was 68 ms, but was 74 ms in LBTP, 74.5 ms in LSFP, and 73.5 ms in LPFP.
CONCLUSIONS
Tailored ECG-based criteria might be useful to confirm LBBP at different pacing locations within the LBB.
背景
心电图（ECG）标准被用于确认左束支（LBB）起搏（LBBP），但目前的截止值从未在不同起搏部位得到验证。
目的
本研究旨在描述 V6-R 波峰时间（RWPT）、V6-V1 间期和 aVL-RWPT 在 LBB 内不同起搏部位的诊断性能，并确定每个起搏部位每个标准的 100%特异性值。
方法
选择确诊为 LBBP 的连续患者。人群根据起搏部位分为亚组：左束支主干起搏（LBTP）、左间隔束支起搏（LSFP）、左后束支起搏（LPFP）和左前束支起搏（LAFP）。
结果
共分析了 147 例明确 LBB 捕获的患者。左束支起搏（82.8%）比 LBTP（17.2%）更常见。在所有亚组中，V6-RWPT、V6-V1 间期和 aVL-RWPT 对 LBBP 鉴别诊断的性能均良好。V6-RWPT 截止值为 75ms 时，100%特异性（SP）可准确鉴别 LBTP；截止值为 68ms 时，100%SP 可准确鉴别 LPFP；截止值为 81ms 时，100%SP 可准确鉴别 LAFP；截止值为 79.5ms 时，100%SP 可准确鉴别 LSFP。V6-V1 间期截止值为 35.5ms 时，100%SP 可准确鉴别 LBTP；截止值为 53.5ms 时，100%SP 可准确鉴别 LPFP；截止值为 41ms 时，100%SP 可准确鉴别 LAFP；截止值为 46ms 时，100%SP 可准确鉴别 LSFP。LAFP 中，aVL-RWPT 截止值为 68ms 时，100%SP 可准确鉴别 LBBP，但 LBTP 中为 74ms，LSFP 中为 74.5ms，LPFP 中为 73.5ms。
结论
针对 LBB 内不同起搏部位制定的基于心电图的标准可能有助于确认 LBBP。
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