Global R-wave peak time for diagnosis of left bundle branch capture.

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.2024.10.038

Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Ignacy Jastrzębski, Patryk Stanisław Michel, Marek Rajzer, Marek Jastrzębski

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Abstract

Background: QRS axis deviation and rS configuration in V6 affect the ability of V6 R-wave peak time (RWPT) criterion to discriminate capture type during left bundle branch area pacing (LBBAP).

Objective: We hypothesized that combining RWPTs from lateral leads: I, aVL, V5, and V6 may better reflect left ventricular activation time and that such a global RWPT may be insensitive to changes in QRS configuration.

Methods: The analysis included 519 electrocardiograms (ECGs) with nonselective left bundle branch pacing (nsLBBP) and 176 ECGs with left ventricular septal pacing (LVSP). Optimal RWPT cutoffs and area under the receiver operating curve (AUC) were determined for each lead and combinations of leads, to find the best RWPT criterion for discriminating nsLBBP from LVSP. Values were reported separately for healthy and diseased left conduction system groups.

Results: The highest AUC of 97.1/89.2% was obtained for the global RWPT, which combined leads I and V6. The AUC for single-lead RWPT, was highest for lead I, followed by V6, V5, and aVL with AUC of 95.1/87.4%, 93.6/87.1%, 93.0/86.5%, and 84.8/74.6%, respectively. The global RWPT criterion was not affected by variations in QRS configuration, as V6 and I RWPTs often showed opposite responses to changes in axis. In contrast, all single-lead RWPT criteria were sensitive to axis deviation and QRS configuration. Diagnostically optimal RWPT cutoffs for global RWPT and lead I RWPT were 162.5/187.5 ms, and 81.5/90.5 ms, respectively.

Conclusion: The global RWPT criterion allows a more accurate diagnosis of LBBAP capture type independent of QRS configuration and axis.

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用于诊断左束支截获的全局 R 波峰值时间。

背景：左束支区起搏（LBBAP）时，V6 的 QRS 轴偏差和 rS 构型会影响 V6 R 波峰值时间（RWPT）标准判别捕获类型的能力：我们假设将来自侧导联 I、aVL、V5 和 V6 的 R 波峰值时间（RWPT）结合在一起，会影响左束支区起搏（LBBAP）时 V6 R 波峰值时间（RWPT）判别捕获类型的能力：目的：我们假设，将 I、aVL、V5 和 V6 侧导联的 RWPT 结合在一起可以更好地反映左心室的激活时间，而且这种全局 RWPT 可能对 QRS 构型的变化不敏感：分析包括 519 张采用非选择性左束支起搏（nsLBBP）的心电图和 176 张采用左室间隔起搏（LVSP）的心电图。为每个导联和导联组合确定了最佳 RWPT 截止值和接收器工作曲线下面积 (AUC)，以找到区分 nsLBBP 和 LVSP 的最佳 RWPT 标准。分别报告了左传导系统健康/疾病组的数值：结合 I 号和 V6 号导联的全局 RWPT 的 AUC 最高，为 97.1/89.2%。单导联 RWPT 的 AUC 以 I 导联最高，其次是 V6、V5 和 aVL，AUC 分别为 95.1/87.4%、93.6/87.1%、93.0/86.5% 和 84.8/74.6%。全局 RWPT 标准不受 QRS 构型变化的影响，因为 V6 和 I RWPT 对轴的变化往往表现出相反的反应。相反，所有单导联 RWPT 标准对轴线偏差和 QRS 构型都很敏感。全局 RWPT 和 I 导联 RWPT 的最佳诊断 RWPT 切点分别为 162.5/187.5 毫秒和 81.5/90.5 毫秒：全局 RWPT 标准能更准确地诊断 LBBAP 捕获类型，而不受 QRS 构型和轴线的影响。

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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.