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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Evaluation of the Criteria to Distinguish Left Bundle Branch Pacing From Left Ventricular Septal Pacing

Shengjie Wu1, Xueying Chen2, Songjie Wang1

  • 1Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China.

JACC. Clinical Electrophysiology
|May 2, 2021
PubMed

Insights

Confirming left bundle branch (LBB) capture is crucial for effective pacing. This study found that an abrupt decrease in stimulus-to-ventricular activation time (Stim-LVAT) of ≥10 ms and selective LBB pacing (LBBP) are reliable indicators for confirming LBB capture.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Distinguishing left bundle branch pacing (LBBP) from left ventricular septum pacing (LVSP) requires validated criteria.
  • Previous methods for confirming left bundle branch (LBB) capture lack comprehensive validation.

Purpose of the Study:

  • To assess the predictive value of electrocardiogram and intracardiac electrogram characteristics for confirming left bundle branch (LBB) capture.
  • To validate criteria for differentiating LBBP from LVSP.

Main Methods:

  • Utilized His bundle pacing lead, LBBP lead, and multielectrode catheter for LBB capture confirmation.
  • Defined direct LBB capture by retrograde His potential and/or anterograde left conduction system potentials.
  • Analyzed parameters including His potential, LBB potential, stimulus-to-peak ventricular activation time (Stim-LVAT), and paced QRS morphology.

Main Results:

  • Thirty patients (21 non-LBBB, 9 LBBB) with confirmed LBB capture were analyzed.
  • 100% of patients showed paced right bundle branch block during LBB capture.
  • Selective LBBP or an abrupt decrease in Stim-LVAT (≥10 ms) reliably indicated LBB capture.

Conclusions:

  • Direct LBB capture is confirmed by retrograde His potential and anterograde left conduction system potentials.
  • Abrupt decrease in Stim-LVAT (≥10 ms) and selective LBBP serve as simple, effective criteria for confirming LBB capture.
Abstract

Keywords:
His bundle pacingcardiac resynchronization therapycriterialeft bundle branchleft bundle branch pacingleft ventricular septal pacingtime from stimulus to left ventricular activation

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