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Estévez Paniagua Á, Briongos-Figuero S, Sánchez Hernández A, Muñoz-Aguilera R. Left bundle fascicular versus left bundle trunk pacing: A comparison of their electrical synchrony parameters. Indian Pacing Electrophysiol J 2024; 24:239-246. [PMID: 39084520 DOI: 10.1016/j.ipej.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/29/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles. OBJECTIVE We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system. METHODS In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters. RESULTS One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced. CONCLUSIONS LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.
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Affiliation(s)
| | - Sem Briongos-Figuero
- Cardiology Department. Infanta Leonor Hospital, Gran Vía Del Este, 28030, Madrid, Spain.
| | - Ana Sánchez Hernández
- Cardiology Department. Infanta Leonor Hospital, Gran Vía Del Este, 28030, Madrid, Spain
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Li Y, Zhang W, Chen K, Lian Z. Comparison of electrocardiogram parameters and echocardiographic response between distinct left bundle branch area pacing modes in heart failure patients. Front Cardiovasc Med 2024; 11:1441241. [PMID: 39267805 PMCID: PMC11390573 DOI: 10.3389/fcvm.2024.1441241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
Background Left bundle branch area pacing (LBBAP) has become an alternative method for cardiac resynchronization therapy. Various modes of LBBAP have been determined, including left bundle trunk pacing (LBTP), left anterior branch pacing (LAFP) and left posterior branch pacing (LPFP). However, whether the outcomes of various pacing modes differ in heart failure (HF) patients is still unclear. This study aimed to compare the electrophysiological characteristics and echocardiographic response rate among those distinct modes of LBBAP. Methods HF patients undergoing successful LBBAP were retrospectively included. Distinct modes of pacing were determined based on paced QRS morphology. The fluoroscopic images were collected to compare the lead tip position between the groups. The electrocardiograms (ECG) before and after LBBAP were used to measure the depolarization (QRS duration [QRSd] and the interventricular delay [IVD]), and the repolarization parameters [QTc, TpeakTend(TpTe), and TpTe/QTc]. The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) of patients were also recorded. In addition, the lead parameters and certain complications were compared. Results A total of 64 HF patients were finally included, consisting of 16 (25.0%) patients in the LBTP group, 22 (34.4%) patients in the LAFP group, and 26 (40.6%) patients in the LPFP group. The distribution features of LBBAP lead tips were significantly related to pacing modes: LBTP was more likely to be in zone 4 while LAFP or LPFP was prone to locate in zone 5. After LBBAP, the ventricular ECG parameters were significantly improved, regardless of pacing modes. Besides, the LVEF of the patients was significantly increased (P < 0.001), and LVEDD was significantly decreased (P < 0.001). There was no difference in the response rate and super-response rate among groups (P > 0.05). In addition, the lead parameters remained stable and no significant difference was observed among groups. Conclusion LPFP was the main pacing mode among HF patients after LBBAP. The paced QRS morphology was significantly related to the position of lead tips. After LBBAP, the ventricular depolarization synchronization and repolarization stability were both significantly improved, regardless of pacing modes. There was no significant difference in the echocardiographic response rate among distinct LBBAP modes.
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Affiliation(s)
- Yao Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Chaumont C, Azincot M, Savouré A, Auquier N, Hamoud RA, Popescu E, Viart G, Mirolo A, Eltchaninoff H, Anselme F. His bundle pacing versus left bundle branch area pacing in patients undergoing atrioventricular node ablation: A prospective and comparative study. Arch Cardiovasc Dis 2024; 117:505-513. [PMID: 38981841 DOI: 10.1016/j.acvd.2024.05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Pacemaker implantation combined with atrioventricular node ablation (AVNA) is a well-established strategy for uncontrolled atrial arrhythmias. Limited data are available regarding His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in this setting. AIM To compare the outcomes of HBP and LBBAP in patients undergoing pacemaker implantation combined with AVN in routine clinical practice. METHODS We prospectively included all patients who underwent AVNA after successful conduction system pacing (CSP) in two hospitals between September 2017 and May 2023. The primary outcome was the 1-year composite of first episode of heart failure hospitalization, symptomatic atrioventricular node reconduction requiring a second AVNA procedure, lead revision or death from any cause. RESULTS A total of 164 patients underwent AVNA following successful CSP (68 HBP and 96 LBBAP). Mean pacemaker implantation and AVNA procedure times were shorter in the LBBAP group than the HBP group (46±18 vs 59±23min; P<0.001 and 31±12 vs 43±22min, respectively; P<0.001). Complete atrioventricular block was more frequently obtained in the LBBAP group (88/96 patients [92%] vs 54/68 patients [79%]; P=0.04). One-year freedom from the composite outcome was more frequent in the LBBAP group (89.7% vs 72.9%; hazard ratio 0.32, 95% confidence interval 0.14-0.72; P=0.01). The strategy was similarly effective in both groups with a significant improvement in NYHA class and left ventricular ejection fraction. A secondary pacing threshold elevation >1V occurred only in the HBP group (11%). CONCLUSION In this prospective, comparative study, LBBAP provided better 1-year outcomes than HBP.
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Affiliation(s)
- Corentin Chaumont
- Department of Cardiology, CHU Rouen, 76000 Rouen, France; Inserm U1096, Université de Rouen Normandie, 76000 Rouen, France
| | - Maxime Azincot
- Department of Cardiology, CHU Rouen, 76000 Rouen, France
| | - Arnaud Savouré
- Department of Cardiology, CHU Rouen, 76000 Rouen, France
| | | | | | - Elena Popescu
- Department of Cardiology, Le Havre Hospital, 76620 Le Havre, France
| | | | - Adrian Mirolo
- Department of Cardiology, CHU Rouen, 76000 Rouen, France
| | - Hélène Eltchaninoff
- Department of Cardiology, CHU Rouen, 76000 Rouen, France; Inserm U1096, Université de Rouen Normandie, 76000 Rouen, France
| | - Frédéric Anselme
- Department of Cardiology, CHU Rouen, 76000 Rouen, France; Inserm U1096, Université de Rouen Normandie, 76000 Rouen, France.
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Cheng C, Sun L, Peng X, Wang Y, Shi L, Zhao T, Wei Z, Tian Y, Liu X. Difference of ventricular synchrony between LBBP, LBFP and LVSP: A speckle tracking echocardiographic study. J Interv Card Electrophysiol 2024; 67:539-547. [PMID: 37574493 DOI: 10.1007/s10840-023-01620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Left bundle branch area pacing (LBBAP) has emerged as a physiological and stable form of pacing. We aim to compare the mechanical ventricular synchrony of LBBP, LBFP, and LVSP. METHODS Proximal Left bundle branch pacing (LBBP), left bundle fascicular pacing (LBFP) and left ventricular septal pacing (LVSP) were identified in patients with bradycardia who successfully underwent LBBAP. Patients with left ventricular ejection fraction (LVEF) < 50% or QRS duration (QRSd) ≥ 120 ms were excluded. By using electrocardiograms, the left ventricular activation time (LVAT) and QRS duration (QRSd) were measured to examine electrophysiological synchrony. As indications of mechanical synchrony, global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and peak strain dispersion (PSD) were evaluated by using 2-dimensional speckle tracking echocardiography (2D-STE). RESULTS In 56 patients, data were collected during LBBP (n = 18), LBFP (n = 16), and LVSP (n = 22). LVSP resulted in a longer LVAT (91.3 ± 14.9 ms) than LBBP (77.1 ± 10.8 ms, P < 0.05) and LBFP (72.1 ± 9.6 ms, P < 0.05), but all three groups had similar QRSd. There were no differences in GLS, GCS, GRS, or PSD between LBBP, LBFP, and LVSP. CONCLUSIONS In patients with normal cardiac function and narrow QRS, though LBBAP with LBB capture resulted in better electrophysiological synchrony than without, the mechanical synchrony of the three groups was comparable.
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Affiliation(s)
- Chaodi Cheng
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lanlan Sun
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, 100020, Beijing, China
| | - Xinyi Peng
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yanjiang Wang
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Liang Shi
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Tong Zhao
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ziyu Wei
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ying Tian
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingpeng Liu
- Department of Cardiology, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Eerenberg F, Luermans J, Lumens J, Nguyên UC, Vernooy K, van Stipdonk A. Exploring QRS Area beyond Patient Selection in CRT-Can It Guide Left Ventricular Lead Placement? J Cardiovasc Dev Dis 2024; 11:18. [PMID: 38248888 PMCID: PMC10816025 DOI: 10.3390/jcdd11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Vectorcardiographic QRS area is a promising tool for patient selection and implantation guidance in cardiac resynchronization therapy (CRT). Research has mainly focused on the role of QRS area in patient selection for CRT. Recently, QRS area has been proposed as a tool to guide left ventricular lead placement in CRT. Theoretically, vector-based electrical information of ventricular fusion pacing, calculated from the basic 12-lead ECG, can give real-time insight into the extent of resynchronization at any LV lead position, as well as any selected electrode on the LV lead. The objective of this review is to provide an overview of the background of vectorcardiographic QRS area and its potential in optimizing LV lead location in order to optimize the benefits of CRT.
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Affiliation(s)
- Frederieke Eerenberg
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Joost Lumens
- Cardiovascular Research Institute Maastricht (CARIM), University Maastricht (UM), 6229 ER Maastricht, The Netherlands;
| | - Uyên Châu Nguyên
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
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Briongos-Figuero S, Estévez Paniagua Á, Sánchez Hernández A, Muñoz-Aguilera R. Redefining QRS transition to confirm left bundle branch capture during left bundle branch area pacing. Front Cardiovasc Med 2023; 10:1217133. [PMID: 37522077 PMCID: PMC10375013 DOI: 10.3389/fcvm.2023.1217133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Background QRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in <50% of LBB area pacing (LBBAP) procedures. Objective We hypothesized that transition from left ventricular septal pacing (LVSP) to LBB pacing (LBBP), when observed during lead penetration into the deep interventricular septum (IVS) with interrupted pacemapping, can suggest LBB capture. Methods QRS transition during lead screwing-in was defined as shortening of paced V6-R wave peak time (RWPT) by ≥10 ms from LVSP to non-selective LBBP (ns-LBBP) obtained during mid to deep septal lead progression at the same target area, between two consecutive pacing manoeuvres. ECG-based criteria were used to compared LVSP and ns-LBBP morphologies obtained by interrupted pacemapping. Results Sixty patients with demonstrated transition from LVSP to ns-LBBP during dynamic manoeuvers were compared to 44 patients with the same transition during lead screwing-in. Average shortening in paced V6-RWPT was similar among study groups (17.3 ± 6.8 ms vs. 18.8 ± 4.9 ms for transition during dynamic manoeuvres and lead screwing-in, respectively; p = 0.719). Paced V6-RWPT and aVL-RWPT, V6-V1 interpeak interval and the recently described LBBP score, were also similar for ns-LBBP morphologies in both groups. LVSP morphologies showed longer V6-RWPT and aVL-RWPT, shorter V6-V1 interpeak interval and lower LBBP score punctuation, without differences among the two QRS transition groups. V6-RWPT < 75 ms or V6-V1 interpeak interval > 44 ms criterion was more frequently achieved in ns-LBBP morphologies obtained during lead screwing-in compared to those obtained during dynamic manoeuvres (70.5% vs. 50%, respectively p = 0.036). Conclusions During LBBAP procedure, QRS transition from LVSP to ns-LBBP can be observed as the lead penetrates deep into the IVS with interrupted pacemapping. Shortening of at least 10 ms in paced V6-RWPT may serve as marker of LBB capture.
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