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Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle
Margarida Pujol-López1,2, Elisenda Ferró2, Roger Borràs1,2
1Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.
Summary
A new stepwise approach using ECG and electrogram criteria simplifies left bundle branch pacing (LBBP) implantation. This method accurately predicts electrical resynchronization, offering a reliable alternative to biventricular pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch pacing (LBBP) is an emerging alternative to biventricular pacing for cardiac resynchronization.
- A standardized method to ensure electrical resynchronization with LBBP is currently lacking.
Purpose of the Study:
- To develop and validate a stepwise criterion for LBBP implantation.
- To simplify the process and guarantee electrical resynchronization.
Main Methods:
- A cohort of 24 patients from the LEVEL-AT trial underwent LBBP implantation and electrocardiographic imaging (ECGI).
- A two-step approach using ECG and electrogram criteria was developed to predict resynchronization.
- ECGI served as the gold standard to assess ventricular activation patterns and left ventricular activation time.
Main Results:
- 91.6% of patients achieved electrical resynchronization confirmed by ECGI.
- The first step of the criteria (RBBB pattern or QRS ≤120ms) showed 95.8% accuracy.
- The second step (selective capture or spike-R <80ms) ensured 100% accuracy in predicting resynchronization.
Conclusions:
- A stepwise application of ECG and electrogram criteria can accurately assess electrical resynchronization with LBBP.
- This approach simplifies LBBP implantation and ensures effective cardiac resynchronization.
Keywords:
Cardiac resynchronizationCriteriaElectrical resynchronizationElectrocardiographic imagingLeft bundle branch pacingMore Related Videos
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