Right bundle branch pacing: Criteria, characteristics, and outcomes
Marek Jastrzębski1, Grzegorz Kiełbasa2, Paweł Moskal3
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland.
Heart Rhythm
|January 26, 2023
Summary
Right bundle branch pacing (RBBP) has unique electrocardiographic features and is found in about 20% of patients intended for His bundle pacing (HBP). Outcomes were similar between RBBP and HBP during follow-up.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Right-sided conduction system pacing (CSP) targets include His bundle and right bundle branch.
- Electrocardiographic (ECG) patterns, diagnostic criteria, and outcomes for right bundle branch pacing (RBBP) are not well-defined.
Purpose of the Study:
- To define the ECG and electrophysiological characteristics of RBBP.
- To compare the outcomes of RBBP with His bundle pacing (HBP).
Main Methods:
- Patients undergoing right CSP were analyzed based on pacing lead characteristics.
- Six criteria were hypothesized to identify RBBP, with pacing parameters, echocardiographic results, and mortality assessed.
Main Results:
- Distinct ECG criteria differentiated RBBP from HBP, with RBBP identified in 19.2% of patients targeted for HBP.
- RBBP showed longer QRS duration and V6 R-wave peak time, with improved sensing compared to HBP.
- No significant differences in capture thresholds, echocardiographic outcomes, or mortality were observed between RBBP and HBP groups.
Conclusions:
- Right bundle branch pacing possesses unique characteristics distinguishing it from His bundle pacing.
- RBBP is identified in approximately one-fifth of patients undergoing intended His bundle pacing.
Related Concept Videos
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
17
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
17
01:21Cardiac Catheterization II: Right Heart Catheterization
76
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
76
01:29Dysrhythmias III: Characteristics of Dysrhythmias
19
Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
19
01:30Pulse rhythm
882
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
882
01:30Dysrhythmias V: Evaluating Dysrhythmias
45
Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
45
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
70
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
70