Assessing modified chest leads as a substitute for electrophysiological systems in left bundle branch area pacing
Hyung Ki Jeong1, Sung Soo Kim2, Hyun Kuk Kim3
1Department of Cardiovascular Medicine, Won Kwang University Medical School, Iksan, Korea.
Background:
Left bundle branch area pacing (LBBAP) typically requires an electrophysiological (EP) system, but access to these systems is limited in many catheterization laboratories. Modified chest leads (MCL1 and MCL6) are commonly used as substitutes for V1 and V6, yet their feasibility as an alternative during LBBAP implantation remains unclear. This study evaluates the utility of MCL-based recordings from a pacing system analyzer (PSA) compared to conventional EP system recordings.
Methods:
This prospective study included all patients undergoing de novo transvenous permanent pacemaker implantation with an expected ventricular pacing burden ≥ 20%. Continuous 12-lead ECG-based EP system recordings were compared with MCL recordings from a PSA. Parameters analyzed included right bundle branch block (RBBB) morphology, QRS transition, left ventricular activation time (LVAT), interpeak interval (V6-V1/MCL6-MCL1), and QRS duration.
Results:
A total of 73 patients (32 men, age 74.3 ± 10.8 years) were included. LBBAP was successfully achieved in all patients. RBBB morphology and QRS transition showed 100% concordance between MCL leads and the EP system. QRS duration (130.63 ± 13.88 ms vs. 124.1 ± 12.04 ms) and LVAT (73.71 ± 9.61 ms vs. 67.08 ± 9.2 ms) were slightly prolonged in MCL measurements but showed minimal bias in Bland-Altman analysis. Intraclass correlation coefficients confirmed strong agreement for QRS duration (0.849), LVAT (0.850), and interpeak interval (0.813).
Conclusion:
MCL-based monitoring closely correlates with the EP system and may serve as a practical and reliable alternative to the EP system, particularly in resource-limited settings.
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