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Distinct intracardiac electrogram waveforms with perforation during left bundle branch area pacing implantation.
Heli Tolppanen1,2, Valerian Valiton1, Samuel Stempfel1
1Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland.
Summary
Left bundle branch area pacing (LBBAP) perforation causes a drop in current of injury (COI) amplitude. Analyzing unipolar electrogram (iEGM) waveforms can help identify perforation during LBBAP lead deployment, improving patient safety.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch area pacing (LBBAP) is an advanced pacing technique.
- Perforation during LBBAP lead implantation can lead to complications.
- Unipolar electrograms (iEGMs) provide signals during lead placement.
Purpose of the Study:
- To systematically analyze unipolar iEGM waveforms during LBBAP perforation.
- To compare these waveforms to those recorded at the final lead position.
- To identify specific waveform characteristics indicative of perforation.
Main Methods:
- Analysis of unipolar iEGMs from 92 patients with LBBAP perforation.
- Comparison of current of injury (COI) amplitude and waveform morphology during perforation versus final lead position.
- Subgroup analysis based on QRS morphology (narrow/non-LBBB vs. LBBB/paced rhythm) and perforation type (macro vs. micro).
Main Results:
- Sensed COI amplitude was significantly lower during perforation (3.0 mV) compared to the final lead position (14.0 mV).
- Patients with narrow QRS/non-LBBB showed QS waveforms (67%), while LBBB/paced rhythm patients exhibited positive R/RS morphologies (93%).
- A sensed Q or S amplitude greater than COI amplitude had 86% sensitivity and 93% specificity for diagnosing perforation in the narrow QRS subgroup.
Conclusions:
- Unipolar iEGM waveform analysis provides additional diagnostic information beyond COI amplitude for LBBAP perforation.
- Specific waveform morphologies (e.g., QS in narrow QRS) can reliably indicate perforation.
- Careful monitoring of iEGM waveforms during lead deployment enhances the safety of LBBAP.
Keywords:
ComplicationsConduction system pacingCurrent of injuryElectrogramLeft bundle branch area pacingPerforationMore Related Videos
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