Role of peri-deployment right ventricular paced-ECG in left bundle area pacing

Area of Science:

• Cardiology and Electrophysiology
• Medical Device Technology
• Cardiac Pacing

Background:

• Left Bundle Area Pacing (LBBAP) is a physiological pacing method with lead implantation challenges.
• Current anatomical approaches for LBBAP lead placement can lead to variability in lead polarity and QRS duration.
• The extensive target zone in anatomical LBBAP can result in inconsistent pacing outcomes.

Purpose of the Study:

• To evaluate the efficacy of peri-deployment electrocardiograms (ECGs) in guiding LBBAP.
• To determine if peri-deployment ECGs can optimize left ventricular activation during LBBAP.
• To identify ECG markers associated with successful LBBAP and improved ventricular activation.

Main Methods:

• Retrospective analysis of 41 patients (54 LBBAP attempts) between September 2020 and June 2021.
• Collection and analysis of demographic data, baseline ECGs, intraprocedural ECGs, and ventricular electrograms.
• Categorization of QRS patterns and polarity analysis, exploring markers for achieving QRS duration <120 ms.

Main Results:

• Successful LBBAP achieved in 81.5% of attempts, with a significant decrease in paced QRS duration (144.5 to 128.8 ms).
• Significant changes in lead polarity scores were observed post-deployment, indicating optimal lead positioning.
• A subgroup with post-deployment QRSd <120 ms showed significantly shorter left ventricular activation time (LVAT) (68.7 vs. 98.4 ms).

Conclusions:

• Peri-deployment ECG assessment is a valuable adjunct to anatomy-based LBBAP for real-time lead positioning.
• Specific ECG axis changes can guide the selection of the left bundle branch during LBBAP.
• Lower pre-deployment paced QRSd and LVAT, along with specific post-deployment polarity, correlate with narrower QRS durations.