Is the pacing site closer to the left ventricular septal endocardium in left bundle branch pacing or in left
Xin-Yi Peng1, Yan-Jiang Wang1, Lan-Lan Sun2
1Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
Insights
Left bundle branch pacing (LBBP) lead tips are significantly closer to the left ventricular (LV) septal endocardium than left ventricular septal pacing (LVSP) leads. Real-time monitoring of lead-to-endocardium distance is crucial during LBBP procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Distinguishing between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) can be challenging.
- Accurate lead placement is critical for effective cardiac pacing and patient outcomes.
Purpose of the Study:
- To compare the echocardiographic distance between the pacing lead tip and the left ventricular (LV) septal endocardium in patients who underwent successful LBBP versus LVSP.
Main Methods:
- Fifty-nine patients undergoing permanent cardiac pacing were included (46 LBBP, 13 LVSP).
- All patients achieved narrow QRS complexes with a right bundle branch block pattern post-procedure.
- A blinded physician measured the lead tip to LV septal endocardium distance using echocardiography after the procedure.
Main Results:
- Paced QRS durations were similar between LBBP and LVSP groups (105.3 ± 15.6 ms vs. 109.2 ± 9.6 ms).
- During diastole, the mean lead tip to LV septal endocardium distance was significantly smaller in the LBBP group (0.6 ± 0.9 mm) compared to the LVSP group (3.0 ± 1.6 mm; P < 0.001).
- During systole, the distance was also significantly smaller in the LBBP group (1.5 ± 1.4 mm) versus the LVSP group (4.3 ± 2.6 mm; P < 0.001).
Conclusions:
- The lead tip landing zone is significantly closer to the LV septal endocardium in LBBP compared to LVSP.
- Real-time intraprocedural monitoring of lead tip to LV septal endocardium distance is recommended for LBBP procedures.
Purpose:
Distinguishing between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) is challenging. This study aimed to compare the echocardiographic distance from the pacing lead tip to the left ventricular (LV) septal endocardium between patients who underwent LBBP and those who underwent LVSP successfully.
Methods:
Fifty-nine consecutive patients (age 71.9 ± 12.0 years, 35.6% male) with traditional indications for permanent cardiac pacing were included (LBBP group, n = 46; LVSP group, n = 13). Unipolar pacing from the final pacing sites generated narrow QRS complexes with a right bundle branch block pattern in all patients. After the procedure, a physician blinded to the group allocation performed echocardiographic measurements of the distance between the lead tip and the LV septal endocardium.
Results:
The mean paced QRS duration was comparable between the LBBP group and the LVSP group (105.3 ± 15.6 ms vs. 109.2 ± 9.6 ms, P = 0.287). In the LBBP group, the interval from the left bundle branch potential to QRS onset was 28.7 ± 9.0 ms. During diastole, the mean distance between the lead tip and the LV septal endocardium was 0.6 ± 0.9 mm in the LBBP group and 3.0 ± 1.6 mm in the LVSP group (P < 0.001). During systole, the distance was 1.5 ± 1.4 mm in the LBBP group and 4.3 ± 2.6 mm in the LVSP group (P < 0.001).
Conclusions:
The landing zone of the lead tip was closer to the LV septal endocardium in the patients who underwent LBBP. There is a need for real-time intraprocedural monitoring of the distance between the lead tip and the LV septal endocardium when performing LBBP.
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