Zhang Lu, Jiang Longfu, Luo Binbin, Shen Jiabo, Wu Hao, Zeng Weifang
Department of Cardiology, Ningbo No. 2 Hospital, Ningbo Cardiovascular Center, Ningbo, Zhejiang, China.
Cardiovascular Disease Clinical Medical Research Center of Ningbo, Ningbo, Zhejiang, China.
Front Cardiovasc Med. 2024 Sep 4;11:1430529. doi: 10.3389/fcvm.2024.1430529. eCollection 2024.
This study aims to explore the different transition patterns and capture types during two bipolar pacing tests based on the selective left bundle branch (LBB) capture determined by the continuous pacing and recording technique.
In total, 67 patients completed two unipolar and two bipolar pacing tests based on selective LBB capture during screwing-in for left bundle branch pacing (LBBP) using the continuous pacing and recording technique. The electrophysiological characteristics and potential mechanisms of different pacing configurations were further evaluated in this study.
We found six transition patterns and derived seven capture types in two bipolar pacing tests according to the analysis of continuous electrocardiogram and electrogram changes. Compared with the conventional configuration of "Tip-Ring+" bipolar pacing, "Ring-Tip+" testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar "LBBP + right ventricular septum pacing (RVSP)" capture type.
In this study, we observed for the first time that "Ring-Tip+" bipolar pacing allows for a lower clinically applicable pacing threshold for simultaneous capture of the LBB and left and right ventricular septum myocardium, and the peculiar "LBBP + RVSP" capture type. This may be a more advantageous physiological pacing configuration, warranting further investigation and application in the future.
Based on the specific selective LBB capture, we first found six transition patterns and derived seven capture types in two bipolar pacing tests due to the different thresholds of the LBB, left ventricular septal myocardial, and right ventricular septal myocardial. Compared with the conventional configuration of "Tip-Ring+" bipolar pacing, "Ring-Tip+" testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar "LBBP + RVSP" capture type. More pacing strategies should be released and investigated to achieve the best physiological pacing according to the individualized electrophysiological characteristics of patients.
本研究旨在基于连续起搏和记录技术确定的选择性左束支（LBB）夺获，探索两次双极起搏测试期间的不同转换模式和夺获类型。
共有67例患者在使用连续起搏和记录技术进行左束支起搏（LBBP）旋入操作期间，基于选择性LBB夺获完成了两次单极和两次双极起搏测试。本研究进一步评估了不同起搏配置的电生理特征和潜在机制。
通过对连续心电图和心内电图变化的分析，我们在两次双极起搏测试中发现了六种转换模式，并得出了七种夺获类型。与传统的“尖端-环极+”双极起搏配置相比，“环极-尖端+”测试在同时夺获LBB以及左、右心室间隔心肌方面具有更低的阈值（0.5 ms时为1.57 V对2.84 V），并且是唯一产生特殊的“LBBP + 右心室间隔起搏（RVSP）”夺获类型的配置。
在本研究中，我们首次观察到“环极-尖端+”双极起搏在同时夺获LBB以及左、右心室间隔心肌方面具有更低的临床适用起搏阈值，以及特殊的“LBBP + RVSP”夺获类型。这可能是一种更具优势的生理性起搏配置，值得未来进一步研究和应用。
基于特定的选择性LBB夺获，由于LBB、左心室间隔心肌和右心室间隔心肌的阈值不同，我们首次在两次双极起搏测试中发现了六种转换模式，并得出了七种夺获类型。与传统的“尖端-环极+”双极起搏配置相比，“环极-尖端+”测试在同时夺获LBB以及左、右心室间隔心肌方面具有更低的阈值（0.5 ms时为1.57 V对2.84 V），并且是唯一产生特殊的“LBBP + RVSP”夺获类型的配置。应根据患者个体化的电生理特征，发布和研究更多起搏策略以实现最佳生理性起搏。
