Electrophysiologic characteristics and clinical correlation of right ventricular activation during left bundle branch area pacing (RV-LBBAP study).

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2024-10-25 DOI:10.1016/j.hrthm.2024.10.049

Shunmuga Sundaram Ponnusamy, Vithiya Ganesan, Vadivelu Ramalingam, Saravana Kumar, Ramvivek Ramamoorthy, Kishore Ramu, Vaishnavi Nagarajan Bhuvaneshwari, Devisree Selvaraj, Avanthika Swisi Alagar, Jananie Dhanapal, Ranjitha Selvaraj, Mariann Diana, Selvaganesh Mariappan, Senthil Murugan, Mahesh Kumar, Pugazhendhi Vijayaraman

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Abstract

Background: Left bundle branch area pacing (LBBAP) results in a right bundle branch (RBB) delay pattern because of preexcitation of the left bundle. The mechanism of right ventricular (RV) activation during LBBAP is largely unknown.

Objective: The aim of the study was to analyze the electrophysiologic characteristics of RV activation by mapping the RBB during LBBAP and its clinical correlation.

Methods: Consecutive patients who underwent successful LBBAP were included. RBB block, RV paced rhythm, and suboptimal intracardiac electrograms were excluded. LBBAP was performed with continuous recording of His bundle (HB) and RBB electrograms. RV activation was classified into 3 types based on the intracardiac electrogram: type I, RBB mediated; type II, transseptal activation; and type III, fusion pattern.

Results: Overall, 86 patients (94% left bundle branch pacing [LBBP]; 6% left ventricular septal pacing) were included. The mean age was 59.6 ± 12.8 years. Nonselective to selective capture transition was noted in 85% (n = 73). In patients with baseline normal QRS (n = 47), during selective LBBP (S-LBBP; n = 39), the most common pattern was type I (n = 34 [87%]), whereas during nonselective LBBP (NS-LBBP; n = 44), type III pattern (n = 40 [91%]) was common. In patients with left bundle branch block (n = 39), type III pattern was common during both S-LBBP and NS-LBBP. Type I pattern was noted only in patients with retrograde HB activation during S-LBBP. Left ventricular septal pacing showed type II activation in both groups. Patients without retrograde HB activation had higher left ventricular end-diastolic diameter, lower left ventricular ejection fraction, and prolonged HV interval compared with those with retrograde HB activation.

Conclusion: Physiologic RBB-mediated (type I) activation of the right ventricle was the most common pattern observed during S-LBBP in patients with intact retrograde HB activation. Type III pattern was the most common pattern observed during NS-LBBP with fusion of multiple wavefronts from anterograde RBB activation, myocardial, and transverse interbundle connections.

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左束支区起搏时右心室激活的电生理特征和临床相关性（RV-LBBAP 研究）。

背景：左束支区域起搏（LBBAP）会因左束预激而导致右束支延迟模式。LBBAP 期间右心室（RV）激活的机制尚不清楚：本研究旨在通过绘制 LBBAP 期间的 RBB 图，分析 RV 激活的电生理特征及其临床相关性：方法：纳入成功接受 LBBAP 的连续患者。排除RBBB、RV节律或不理想的心内电图。LBBAP 在连续记录 His-bundle（HB）和 RBB 电图的情况下进行。根据心内电图将 RV 激活分为 3 种类型--（a）I 型（RBB 介导）（b）II 型（横隔膜激活）和（c）III 型（融合模式）：共纳入 86 名患者（94% LBBP；6% LVSP）。平均年龄（59.6±12.8）岁。85%的患者（n=73）从非选择性捕获过渡到选择性捕获。在基线正常 QRS（n=47）的患者中，在选择性 LBBP（S-LBBP；n=39）期间，最常见的模式为 I 型（n=35；87%），而在非选择性 LBBP（NS-LBBP；n=44）期间，常见的模式为 III 型（n=40；91%）。在 LBBB 患者（39 人）中，S-LBBP 和 NS-LBBP 期间均常见 III 型模式。只有在 S-LBBP 期间出现逆行 HB 激活的患者才会出现 I 型模式。两组患者的 LVSP 均显示为 II 型激活。与HB逆行激活的患者相比，没有HB逆行激活的患者左心室舒张末期直径较大，LVEF较低，HV间期延长：结论：在逆行 HB 激活完好的患者中，生理 RBB 介导的 RV 激活（I 型）是 S-LBBP 期间最常见的模式。在 NS-LBBP 期间观察到的最常见模式是 III 型模式，它融合了来自逆行 RBB 激活、室间隔心肌和横向束间连接的多个波面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.