TY - JOUR
T1 - Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing
AU - Curila, K.
AU - Jurak, P.
AU - Prinzen, F.
AU - Jastrzebski, M.
AU - Waldauf, P.
AU - Halamek, J.
AU - Tothova, M.
AU - Znojilova, L.
AU - Smisek, R.
AU - Kach, J.
AU - Poviser, L.
AU - Linkova, H.
AU - Plesinger, F.
AU - Moskal, P.
AU - Viscor, I.
AU - Vondra, V.
AU - Leinveber, P.
AU - Osmancik, P.
N1 - Funding Information:
This paper was supported by the Charles University Research Program Cooperatio – Cardiovascular Science (KC), Ministry of Health of the Czech Republic, grant number NU21-02-00584 (KC), National Institute for Metabolic and Cardiovascular Research “CarDia” (project nr. LX22NPO5104) (KC), by the CAS project RVO: 68081731 (PJ) and the European Regional Development Fund – Project ENOCH No. CZ.02.1.01/0.0/0.0/16_019/0000868 (PL).
Publisher Copyright:
2023 Curila, Jurak, Prinzen, Jastrzebski, Waldauf, Halamek, Tothova, Znojilova, Smisek, Kach, Poviser, Linkova, Plesinger, Moskal, Viscor, Vondra, Leinveber and Osmancik.
PY - 2023/3/22
Y1 - 2023/3/22
N2 - BackgroundLeft bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. MethodsIn patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. ResultsaLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean -9 ms; 95% CI (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. aLBBP resulted in e-DYS -9 ms (-12; -6) vs. e-DYS 10 ms (7;14), p < 0.001 during HBP. Local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). ConclusionAlthough aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.
AB - BackgroundLeft bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. MethodsIn patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. ResultsaLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean -9 ms; 95% CI (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. aLBBP resulted in e-DYS -9 ms (-12; -6) vs. e-DYS 10 ms (7;14), p < 0.001 during HBP. Local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). ConclusionAlthough aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.
KW - ultra-high-frequency ECG
KW - dyssynchrony
KW - LBBP
KW - anodal septal pacing
KW - His bundle pacing
KW - CONDUCTION SYSTEM
U2 - 10.3389/fcvm.2023.1140988
DO - 10.3389/fcvm.2023.1140988
M3 - Article
C2 - 37034324
SN - 2297-055X
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
IS - 1
M1 - 1140988
ER -