通过激活序列特征对左束支区域起搏时心室同步性进行基于心电图的评估。
ECG-based evaluation of ventricular synchrony in left bundle branch area pacing through characterization of the activation sequence.
作者信息
Sales-Belles Clara, Mincholé Ana, Melero-Polo Jorge, Cabrera-Ramos Mercedes, Vadillo-Martín Pablo, Montilla-Padilla Isabel, Sorinas-Villanueva Laura, Julián-García Inés, Mayo-Carlos Gualber Vitto, Ruiz-Arroyo José Ramón, Pueyo Esther, Ramos-Maqueda Javier
机构信息
BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, University of Zaragoza, Zaragoza, Spain.
CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain.
出版信息
Sci Rep. 2025 May 4;15(1):15584. doi: 10.1038/s41598-025-98608-6.
Left bundle branch area pacing (LBBAP) overcomes ventricular dyssynchrony induced by conventional right ventricular pacing (RVP). Despite QRS duration (QRSd) being the standard ECG marker for biventricular synchrony, it lacks insights into the ventricular activation sequence. Our aim is to assess biventricular synchrony by characterizing the ventricular activation sequence and introducing robust markers using the 12-lead ECG. A prospective single-center study was conducted, involving patients with pacemaker indication due to bradycardia. Patients were divided into LBBAP and RVP, and classified by baseline-QRS morphology. To assess biventricular synchrony, low frequency-based QRS analysis was performed to compute the ventricular activation sequence and precordial activation delay (pAD). Additional QRS markers including QRSd, QRS60, and QRS area (QRSa) were calculated. A total of 176 patients (107 LBBAP, 69 RVP) were included. The paced ventricular activation sequence indicated a more physiological pattern after LBBAP than RVP, with lower pAD values in narrow QRS, RBBB, and LBBB subgroups [ - 10( - 20,14) vs. 26(5, 39) ms; - 18( - 30, - 8) vs. 34(26, 55) ms; 10( - 14, 25) vs. 32(12, 48) ms] (p < 0.01). In all subgroups, QRS60 showed lower values after LBBAP than RVP [52(41, 62) vs.73(65, 80) ms; 60(55, 66) vs. 77(67, 83) ms; 59(53, 64) vs. 77(74, 82) ms] (p < 0.01) and QRSa were also lower [53(38, 66) vs. 121(92, 143) μVs; 60(50, 89) vs. 124(97, 159) μVs; 62(52, 80) vs. 133(99, 148) μVs] (p < 0.01). pAD provides valuable insights into ventricular activation beyond paced-QRSd. Together with QRS60 and QRSa, pAD could be a promising tool to assess biventricular synchrony.
左束支区域起搏（LBBAP）克服了传统右心室起搏（RVP）引起的心室不同步。尽管QRS波时限（QRSd）是双心室同步的标准心电图标志物，但它缺乏对心室激动顺序的深入了解。我们的目的是通过表征心室激动顺序并使用12导联心电图引入可靠的标志物来评估双心室同步性。进行了一项前瞻性单中心研究，纳入因心动过缓有起搏器植入指征的患者。患者被分为LBBAP组和RVP组，并根据基线QRS形态进行分类。为了评估双心室同步性，进行了基于低频的QRS分析以计算心室激动顺序和胸前导联激动延迟（pAD）。还计算了其他QRS标志物，包括QRSd、QRS60和QRS面积（QRSa）。共纳入176例患者（107例LBBAP组，69例RVP组）。起搏心室激动顺序显示，LBBAP组比RVP组的模式更接近生理状态，在窄QRS、右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）亚组中pAD值更低[-10（-20，14）ms对26（5，39）ms；-18（-30，-8）ms对34（26，55）ms；10（-14，25）ms对32（12，48）ms]（p<0.01）。在所有亚组中，LBBAP组的QRS60值均低于RVP组[52（41，62）ms对73（65，80）ms；60（55，66）ms对77（67，83）ms；59（53，64）ms对77（74，82）ms]（p<0.01），QRSa也更低[53（38，66）μVs对121（92，143）μVs；60（50，89）μVs对124（97，159）μVs；62（52，80）μVs对133（99，148）μVs]（p<0.01）。pAD为起搏QRSd之外的心室激动提供了有价值的见解。与QRS60和QRSa一起，pAD可能是评估双心室同步性的一个有前景的工具。
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