Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad241.
Left bundle branch area pacing (LBBAP) is a potential alternative to His bundle pacing. This study aimed to investigate the impact of different septal locations of pacing leads on the diversity of QRS morphology during non-selective LBBAP.
Non-selective LBBAP and left ventricular septal pacing (LVSP) were achieved in 50 and 21 patients with atrioventricular block, respectively. The electrophysiological properties of LBBAP and their relationship with the lead location were investigated. QRS morphology and axis showed broad variations during LBBAP. Echocardiography demonstrated a widespread distribution of LBBAP leads in the septum. During non-selective LBBAP, the qR-wave in lead V1 indicated that the primary location for pacing lead was the inferior septum (93%). The non-selective LBBAP lead was deployed deeper than the LVSP lead in the inferior septum. The Qr-wave in lead V1 with the inferior axis in aVF suggested pacing lead placement in the anterior septum. The penetration depth of the non-selective LBBAP lead in the anterior septum was significantly shallower than that in the inferior septum (72 ± 11 and 87 ± 8%, respectively). In lead V6, the deep S-wave indicated the time lag between the R-wave peak and the latest ventricular activation in the coronary sinus trunk, with pacemaker leads deployed closer to the left ventricular apex.
Different QRS morphologies and axes were linked to the location of the non-selective LBBAP lead in the septum. Various lead deployments are feasible for LBBAP, allowing diversity in the conduction system capture in patients with atrioventricular block.
左束支区域起搏（LBBAP）是希氏束起搏的一种潜在替代方法。本研究旨在探讨不同间隔部位起搏导线对非选择性 LBBAP 时 QRS 形态多样性的影响。
分别在 50 例和 21 例房室传导阻滞患者中实现了非选择性 LBBAP 和左室间隔起搏（LVSP）。研究了 LBBAP 的电生理特性及其与导线位置的关系。LBBAP 时 QRS 形态和轴表现出广泛的变化。超声心动图显示 LBBAP 导线在间隔中广泛分布。在非选择性 LBBAP 时，V1 导联的 qR 波表明起搏导线的主要位置是下间隔（93%）。非选择性 LBBAP 导线在下间隔中的植入深度深于 LVSP 导线。下侧壁导联 V1 的 Qr 波和下侧壁导联 aVF 的 Qr 波提示起搏导线位于前间隔。非选择性 LBBAP 导线在前间隔中的穿透深度明显浅于下间隔（分别为 72 ± 11%和 87 ± 8%）。在 V6 导联中，深 S 波表明 R 波峰值与冠状窦干最晚心室激活之间的时间延迟，提示起搏器导线更靠近左心室心尖。
不同的 QRS 形态和轴与间隔中非选择性 LBBAP 导线的位置相关。对于 LBBAP，各种导线的植入是可行的，可以在房室传导阻滞患者中实现不同的传导系统捕获。
