Left bundle fascicular versus left bundle trunk pacing: A comparison of their electrical synchrony parameters

Q3 Medicine Indian Pacing and Electrophysiology Journal Pub Date : 2024-09-01 DOI:10.1016/j.ipej.2024.07.006

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Abstract

Background

Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles.

Objective

We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system.

Methods

In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters.

Results

One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced.

Conclusions

LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.

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左束筋膜起搏与左束主干起搏：两者电气同步参数的比较。

背景：人体左束支（LBB）解剖结构的变化对左心室除极顺序有显著影响。然而，人们对不同 LBB 束支起搏的电生理特征知之甚少：我们的目的是分析 LBB 起搏（LBBP）的不同心电图特征与 LBB 系统起搏部位的关系：在 200 名确诊 LBBP 的连续患者中，我们根据 LB 电位和起搏 QRS 形态的存在，区分了左束干捕获（LBTP）和任何 LB 筋膜起搏（LBFP）。我们比较了它们的手术方法、LBBP 标准和电同步参数：结果：173 名 LBFP 患者与 25 名 LBTP 患者进行了比较。在 LBFP 患者中，左室间隔和后束明显多于左前束（分别为 46.8%、41.0% 和 12.2%）。QRS转换标准（80.0% vs 61.8%；p=0.077）、选择性LBBP（40.0 vs 21.5%；p=0.101）、起搏QRS宽度（110.3±16.8 ms vs 115.4±14.9 ms；p=0.117）、V6-RWPT（79.2±10.7 ms vs 75.3±9.7 ms; p=0.068）和峰间期（42.5±19.1 ms vs 45.7±12.9 ms; p=0.282）在 LBTP 和 LBFP 之间无显著差异。所有短期并发症都发生在 LBFP，主要是室间隔穿孔（23 例），起搏参数没有任何差异。在LBFP亚组中，只有后束起搏时aVL-RWPT较长：结论：在未经选择的连续 LBBP 患者中，LBFP 比 LBTP 更为普遍。LBFP 似乎更可行，在电同步性和起搏安全性方面与 LBTP 不相上下。

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来源期刊

Indian Pacing and Electrophysiology Journal Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

61 days

期刊介绍： Indian Pacing and Electrophysiology Journal is a peer reviewed online journal devoted to cardiac pacing and electrophysiology. Editorial Advisory Board includes eminent personalities in the field of cardiac pacing and electrophysiology from Asia, Australia, Europe and North America.