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The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture

Marek Jastrzębski1, Haran Burri2, Grzegorz Kiełbasa1

  • 1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, 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
|July 13, 2021
PubMed

Insights

The V6-V1 interpeak interval effectively differentiates between selective and non-selective left bundle branch (LBB) area pacing, offering a new diagnostic tool for LBB capture. This ECG measurement helps distinguish pacing types for improved patient management.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Left bundle branch (LBB) pacing is a crucial technique for cardiac resynchronization therapy.
  • Differentiating between selective LBB, non-selective LBB, and left ventricular septal (LVS) pacing is essential for optimizing pacing strategies.
  • Current methods for distinguishing these pacing types can be complex and may not always be definitive.

Purpose of the Study:

  • To investigate the utility of the V6-V1 interpeak interval in differentiating between selective (s-LBB), non-selective (ns-LBB), and left ventricular septal (LVS) pacing.
  • To determine if R-wave peak times (RWPT) in V1 and V6 correlate with different LBB area capture patterns.
  • To establish the V6-V1 interpeak interval as a novel diagnostic criterion for LBB area capture.

Main Methods:

  • Analysis of electrocardiograms (ECGs) from 124 patients with confirmed LBB capture.
  • Comparison of V6-V1 interpeak interval, V6RWPT, and V1RWPT across different LBB capture types (s-LBB, ns-LBB, LVS).
  • Statistical analysis including receiver operating characteristic (ROC) curve analysis to determine optimal cut-off values.

Main Results:

  • Loss of LVS capture increased V1RWPT (≥15 ms) without affecting V6RWPT.
  • Loss of LBB capture increased V6RWPT (≥15 ms) with minimal impact on V1RWPT.
  • The V6-V1 interval was longest in s-LBB (62.3 ± 21.4 ms), intermediate in ns-LBB (41.3 ± 14.0 ms), and shortest in LVS capture (26.5 ± 8.6 ms).
  • An optimal V6-V1 interval of 33 ms differentiated ns-LBB from LVS capture (AUC 84.7%).
  • A cut-off of >44 ms achieved 100% specificity for diagnosing LBB capture.

Conclusions:

  • The V6-V1 interpeak interval is a valuable and promising new criterion for diagnosing left bundle branch area capture.
  • This ECG-derived measurement can reliably distinguish between different types of LBB pacing.
  • The V6-V1 interval offers a simpler and potentially more accurate method for assessing LBB capture efficacy.
Abstract

Keywords:
Conduction system pacingElectrocardiogramLeft bundle branch captureLeft bundle branch pacingLeft ventricular septal capture

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