Pacing system analyzers to guide conduction system pacing implantation procedures: A comparison study of intracardiac and surface signals with an electrophysiology recording system.

BACKGROUND

Left bundle branch area pacing (LBBAP) needs confirmation of left conduction system capture assessed by testing of different electrical parameters. Guidelines recommend the use of an electrophysiology recording system (EP-RS) to guide conduction system pacing procedures. However, some experienced centers perform LBBAP procedures without an EP-RS.

OBJECTIVE

We aimed to assess whether LBBAP criteria can be measured by the signals provided by the pacing system analyzers (PSAs) as a surrogate for the EP-RS to simplify and universalize the technique.

METHODS

This was an observational, prospective, multicenter study assessing the current LBBAP criteria using the PSA compared with the EP-RS during conduction system pacing procedures.

RESULTS

A consecutive 108 patients were included. Baseline QRS duration was 130 ± 29 ms in the EP-RS vs 128 ± 29 ms in the PSA (P = .7). An initial W morphology in V was noted in 88% of patients with the EP-RS vs 86% of patients with the PSA (P = .7) during unipolar pacing. The QRS duration (122 ± 17 ms vs 123 ± 19 ms; P = .7), the R-wave peak time interval in V (80 ± 13 ms vs 79 ± 14 ms (P = .9), and the V-V interpeak interval (39 ± 16 ms vs 38 ± 17 ms (P = .7) were superimposable in the EP-RS compared with the PSA. Pearson coefficients for the last 2 criteria were 0.85 (P < .0001) and 0.94 (P < .0001), respectively. According to the current criteria, 91.5% of patients received a successful LBBAP implant using the EP-RS. Based on the PSA measurements, 96.6% of these patients met LBBAP criteria.

CONCLUSION

Criteria for LBBAP can be assessed by PSAs with high accuracy. These results provide the basis for the usefulness of the PSA to guide LBBAP procedures.