Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China.
Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China.
Heart Rhythm. 2024 Mar;21(3):294-300. doi: 10.1016/j.hrthm.2023.11.003. Epub 2023 Nov 10.
Left bundle branch (LBB) pacing (LBBP) is a physiological pacing; however, the accuracy of current electrocardiographic criteria for LBBP remains inadequate.
The purpose of this study was to establish a novel individualized criterion to improve the accuracy of LBBP determination in patients with a narrow QRS complex.
Patients in whom both LBBP and left ventricular septal pacing (LVSP) were acquired during operation were enrolled. LBB conduction time (LBBCT) was measured from LBB potential (LBB) to intrinsic QRS onset. LBB-VRWPT, Native-VRWPT, and Paced-VRWPT were respectively measured from LBB, intrinsic QRS onset, and stimulus to R-wave peak in V. ΔVRWPT was the difference value between Paced-VRWPT and Native-VRWPT. The accuracy of ΔVRWPT criterion for determining LBBP was evaluated.
In all 71 enrolled patients, ΔVRWPT was <30 ms during LBBP (21.3 ± 4.6 ms; range 9.3-28.3 ms) but was >30 ms during LVSP (38.5 ± 4.6 ms; range 31.1-47.0 ms). The probability distribution of ΔVRWPT was well separated between LBBP and LVSP. Sensitivity and specificity of the novel criterion of "ΔVRWPT <30 ms" for determining LBBP both were 100%. However, the optimal cutoff value of Paced-VRWPT for validation of LBBP was 64.2 ms, and sensitivity and specificity were 84.5% and 97.2%, respectively. Paced-VRWPT during LBBP was equivalent to LBB-VRWPT in all patients. There was a strong linear correlation between Native-VRWPT and LBB-VRWPT (r = 0.796; P <.001).
ΔVRWPT could be an accurate individualized criterion for determining LBB capture with high sensitivity and specificity and was superior over the fixed Paced-VRWPT criterion.
左束支（LBB）起搏（LBBP）是一种生理性起搏；然而，当前心电图标准用于 LBBP 的准确性仍不够。
本研究旨在建立一种新的个体化标准，以提高窄 QRS 综合波患者中 LBBP 确定的准确性。
纳入术中获得 LBBP 和左室间隔起搏（LVSP）的患者。从 LBB 电位（LBB）到固有 QRS 起始测量 LBB 传导时间（LBBCT）。分别从 LBB、固有 QRS 起始和刺激到 V 波 R 波峰测量 LBB-VRWPT、Native-VRWPT 和 Paced-VRWPT。ΔVRWPT 是 Paced-VRWPT 与 Native-VRWPT 之间的差值。评估了 ΔVRWPT 标准用于确定 LBBP 的准确性。
在所有 71 例纳入患者中，LBBP 时 ΔVRWPT<30 ms（21.3±4.6 ms；范围 9.3-28.3 ms），但 LVSP 时 ΔVRWPT>30 ms（38.5±4.6 ms；范围 31.1-47.0 ms）。ΔVRWPT 的概率分布在 LBBP 和 LVSP 之间很好地分开。用于确定 LBBP 的新“ΔVRWPT<30 ms”标准的敏感性和特异性均为 100%。然而，用于验证 LBBP 的 Paced-VRWPT 的最佳截断值为 64.2 ms，敏感性和特异性分别为 84.5%和 97.2%。在所有患者中，LBBP 时的 Paced-VRWPT 与 LBB-VRWPT 相当。Native-VRWPT 与 LBB-VRWPT 之间存在很强的线性相关性（r=0.796；P<.001）。
ΔVRWPT 可以作为一种准确的个体化标准，用于确定具有高敏感性和特异性的 LBB 捕获，并且优于固定的 Paced-VRWPT 标准。
