Transseptal Transition Patterns During Left Bundle Branch Area Lead Implantation
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.
JACC. Clinical Electrophysiology
|October 10, 2024
Summary
Continuous monitoring of electrocardiogram (ECG) and myocardial current of injury (COI) during left bundle branch pacing (LBBP) lead implantation identified distinct beat-to-beat patterns. Sudden ECG and COI changes reliably indicate successful LBBP capture.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Left bundle branch pacing (LBBP) lead implantation involves navigating the cardiac septum.
- Monitoring electrocardiogram (ECG) and myocardial current of injury (COI) provides real-time feedback during lead placement.
Purpose of the Study:
- To characterize ECG and COI changes during septal lead implantation.
- To differentiate between LBBP and left ventricular septal pacing (LVSP) based on these changes.
- To assess lead depth and capture type instantaneously.
Main Methods:
- Continuous ECG and COI recording during LBBP lead implantation.
- Analysis of beat-to-beat changes in QRS, ST-T, and COI.
- Identification of sudden versus gradual transition patterns.
Main Results:
- LBBP was achieved in 77.4% of 212 patients.
- A sudden transition pattern, observed in 80.7%, showed high sensitivity (98.8%) and specificity (81.2%) for LBBP.
- A significant COI drop was noted in 53.9% of patients, correlating with LBBP acquisition.
Conclusions:
- Lead capture during LBBP is a beat-to-beat phenomenon.
- Sudden transition patterns indicate successful LBBP, while gradual patterns suggest LVSP.
- A sudden COI drop is a key indicator of reaching the left subendocardial region.
