Eltsov Ivan, Del Monte Alvise, Pannone Luigi, Overeinder Ingrid, Della Rocca Domenico, Scacciavillani Roberto, Verbrugge Frederik H, Zeng Qingguo, Bala Gezim, Paparella Andrea Maria, Talevi Giacomo, Stroker Erwin, Sieira Juan, Gharaviri Ali, Sarkozy Andrea, Chierchia Gian-Battista, La Meir Mark, de Asmundis Carlo, Almorad Alexandre
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium.
Heart Rhythm O2. 2024 Dec 6;6(3):329-338. doi: 10.1016/j.hroo.2024.11.026. eCollection 2025 Mar.
Left bundle branch area pacing (LBBAP) has become the procedure of choice for various indications including atrioventricular block and considered to be physiologic modality of pacing compared with right ventricular apex pacing.
The purpose of this study was to assess ventricular activation and synchrony in patients with an LBBAP device using electrocardiographic imaging (ECGI).
A total of 25 consecutive patients underwent an LBBAP device implantation were included in the study. Electrocardiography (ECG) and ECGI analyses have been performed the day after implantation. Native and paced QRS, left ventricular activation time, right ventricular activation time, and V1-V6 activation delay were calculated using ECG. Total ventricular activation time, left ventricular activation time, intrinsic left ventricular activation time, right ventricular activation time, intrinsic right ventricular activation time, and intraventricular dyssynchrony were calculated based on ECGI. All patients have been followed up to 12 months.
All patients were divided in 2 groups (wide and narrow QRS) based on intrinsic ECG and then based on paced ECG parameters. The study showed that for initially narrow QRS group activation time and synchrony during pacing was comparable to native. In wide QRS group these parameters were significantly improved. For paced rhythm analysis classic ECG LBBAP parameters (paced QRS and left ventricular activation time) were not sufficient to properly evaluate the ventricular activation for paced rhythm. Discordance between classic ECG parameters and ECGI analysis was identified. Two additional 12-lead ECG parameters predicting the ECGI measurements were found. Follow-up did not show any worsening of ejection fraction, paced QRS, or pacing parameters.
ECG imaging can bring a significant value into assessing the efficacy of new pacing modalities and provide much more data for precise determination of implantation outcome including detailed activation assessment and comparison with intrinsic conduction. Key ECGI values confirming proper ventricular activation have been defined, and corresponding 12-lead parameters were also identified, which allows to predict ventricular activation by using 12-lead ECG only.
左束支区域起搏（LBBAP）已成为包括房室传导阻滞在内的各种适应症的首选治疗方法，与右心室心尖部起搏相比，被认为是一种生理性起搏方式。
本研究旨在使用心电图成像（ECGI）评估植入LBBAP装置患者的心室激动和同步性。
本研究共纳入25例连续接受LBBAP装置植入的患者。植入后第二天进行了心电图（ECG）和ECGI分析。使用ECG计算窦性和起搏QRS波、左心室激动时间、右心室激动时间以及V1-V6激动延迟。基于ECGI计算全心室激动时间、左心室激动时间、固有左心室激动时间、右心室激动时间、固有右心室激动时间和心室内不同步性。所有患者均随访12个月。
根据固有ECG，然后根据起搏ECG参数，将所有患者分为两组（宽QRS波和窄QRS波）。研究表明，对于最初窄QRS波组，起搏期间的激动时间和同步性与窦性相当。在宽QRS波组中，这些参数得到了显著改善。对于起搏心律分析，经典ECG的LBBAP参数（起搏QRS波和左心室激动时间）不足以正确评估起搏心律的心室激动。发现了经典ECG参数与ECGI分析之间的不一致。发现了另外两个预测ECGI测量值的12导联ECG参数。随访未显示射血分数、起搏QRS波或起搏参数有任何恶化。
ECG成像在评估新起搏方式的疗效方面具有重要价值，并可为精确确定植入结果提供更多数据，包括详细的激动评估以及与固有传导的比较。已定义了确认心室正确激动的关键ECGI值，还确定了相应的12导联参数，这使得仅使用12导联ECG就能预测心室激动。
