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Electrocardiographic characterization of non-selective His-bundle pacing: validation of novel diagnostic criteria

Marek Jastrzębski1, Paweł Moskal1, Karol Curila2

  • 1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|October 10, 2019
PubMed

Insights

This study identifies electrocardiogram (ECG) criteria to detect loss of His-bundle (HB) capture during pacing. The developed HB ECG algorithm accurately differentiates between non-selective HB pacing and right ventricular pacing, aiding clinical management.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Permanent His-bundle (HB) pacing is a specialized cardiac pacing technique.
  • Confirming successful HB capture via standard electrocardiogram (ECG) is crucial for effective treatment.
  • Loss of HB capture can lead to suboptimal pacing outcomes.

Purpose of the Study:

  • To identify reliable ECG criteria for detecting the loss of HB capture during non-selective (ns)-HB pacing.
  • To develop and validate an ECG algorithm for diagnosing HB capture status.
  • To establish definitive ECG criteria for confirming ns-HB capture.

Main Methods:

  • Recruited patients with permanent HB pacing devices.
  • Collected ECGs during both ns-HB pacing and periods of lost HB capture (RV-only).
  • Developed and validated an 'HB ECG algorithm' using QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6.

Main Results:

  • Analyzed 353 ECGs from 226 patients.
  • The 'HB ECG algorithm' achieved 87.1% overall classification accuracy.
  • Sensitivity was 93.2% and specificity was 83.9% for the algorithm.
  • Criteria for definitive ns-HB capture (no QRS slur/notch in specific leads and V6 RWPT ≤ 100 ms) showed 100% specificity.

Conclusions:

  • A novel ECG algorithm and specific criteria for diagnosing loss of HB capture were developed and validated.
  • This algorithm can aid in monitoring HB pacing effectiveness during follow-up.
  • Definitive ns-HB capture criteria provide a reliable procedural endpoint for HB device implantation.
Abstract

Keywords:
ElectrocardiogramHis-bundle pacingLoss of captureNon-selective pacing

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