{"title":"不同左束支双极起搏配置中的六种过渡模式和七种捕获类型","authors":"Lu Zhang, Longfu Jiang, Binbin Luo, Jiabo Shen, Hao Wu, Weifang Zeng","doi":"10.3389/fcvm.2024.1430529","DOIUrl":null,"url":null,"abstract":"AimsThis study aims to explore the different transition patterns and capture types during two bipolar pacing tests based on the selective left bundle branch (LBB) capture determined by the continuous pacing and recording technique.MethodsIn total, 67 patients completed two unipolar and two bipolar pacing tests based on selective LBB capture during screwing-in for left bundle branch pacing (LBBP) using the continuous pacing and recording technique. The electrophysiological characteristics and potential mechanisms of different pacing configurations were further evaluated in this study.ResultsWe found six transition patterns and derived seven capture types in two bipolar pacing tests according to the analysis of continuous electrocardiogram and electrogram changes. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + right ventricular septum pacing (RVSP)” capture type.ConclusionsIn this study, we observed for the first time that “Ring−Tip+” bipolar pacing allows for a lower clinically applicable pacing threshold for simultaneous capture of the LBB and left and right ventricular septum myocardium, and the peculiar “LBBP + RVSP” capture type. This may be a more advantageous physiological pacing configuration, warranting further investigation and application in the future.Lay summaryBased on the specific selective LBB capture, we first found six transition patterns and derived seven capture types in two bipolar pacing tests due to the different thresholds of the LBB, left ventricular septal myocardial, and right ventricular septal myocardial. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + RVSP” capture type. More pacing strategies should be released and investigated to achieve the best physiological pacing according to the individualized electrophysiological characteristics of patients.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Six transition patterns and seven capture types in different left bundle branch bipolar pacing configurations\",\"authors\":\"Lu Zhang, Longfu Jiang, Binbin Luo, Jiabo Shen, Hao Wu, Weifang Zeng\",\"doi\":\"10.3389/fcvm.2024.1430529\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"AimsThis study aims to explore the different transition patterns and capture types during two bipolar pacing tests based on the selective left bundle branch (LBB) capture determined by the continuous pacing and recording technique.MethodsIn total, 67 patients completed two unipolar and two bipolar pacing tests based on selective LBB capture during screwing-in for left bundle branch pacing (LBBP) using the continuous pacing and recording technique. The electrophysiological characteristics and potential mechanisms of different pacing configurations were further evaluated in this study.ResultsWe found six transition patterns and derived seven capture types in two bipolar pacing tests according to the analysis of continuous electrocardiogram and electrogram changes. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + right ventricular septum pacing (RVSP)” capture type.ConclusionsIn this study, we observed for the first time that “Ring−Tip+” bipolar pacing allows for a lower clinically applicable pacing threshold for simultaneous capture of the LBB and left and right ventricular septum myocardium, and the peculiar “LBBP + RVSP” capture type. This may be a more advantageous physiological pacing configuration, warranting further investigation and application in the future.Lay summaryBased on the specific selective LBB capture, we first found six transition patterns and derived seven capture types in two bipolar pacing tests due to the different thresholds of the LBB, left ventricular septal myocardial, and right ventricular septal myocardial. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + RVSP” capture type. More pacing strategies should be released and investigated to achieve the best physiological pacing according to the individualized electrophysiological characteristics of patients.\",\"PeriodicalId\":12414,\"journal\":{\"name\":\"Frontiers in Cardiovascular Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Cardiovascular Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fcvm.2024.1430529\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Cardiovascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fcvm.2024.1430529","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的 本研究旨在探讨基于连续起搏和记录技术确定的选择性左束支(LBB)捕获在两次双极起搏试验中的不同过渡模式和捕获类型。方法 共有67名患者在使用连续起搏和记录技术进行左束支起搏(LBBP)拧入时完成了基于选择性LBB捕获的两次单极和两次双极起搏试验。结果 根据对连续心电图和电图变化的分析,我们在两次双极起搏试验中发现了六种过渡模式,并得出了七种捕获类型。与传统的 "Tip-Ring+"双极起搏配置相比,"Ring-Tip+"测试同时捕获 LBB 和左右室间隔心肌的阈值较低(0.5 ms 时为 1.57 V vs. 2.84 V),并且是唯一能产生奇特的 "LBBP + 右室间隔起搏(RVSP)"捕获类型的配置。结论在这项研究中,我们首次观察到 "环尖+"双极起搏可使同时捕获 LBB 和左右室间隔心肌的临床适用起搏阈值更低,并可产生奇特的 "LBBP + RVSP "捕获类型。基于特定的选择性 LBB 捕获,我们首先在两个双极起搏试验中发现了六种过渡模式,并根据 LBB、左室间隔心肌和右室间隔心肌的不同阈值得出了七种捕获类型。与传统的 "Tip-Ring+"双极起搏配置相比,"Ring-Tip+"测试对同时捕获 LBB 和左右室间隔心肌的阈值较低(0.5 ms 时为 1.57 V 对 2.84 V),并且是唯一能产生奇特的 "LBBP + RVSP "捕获类型的配置。应根据患者的个体化电生理特点发布和研究更多起搏策略,以实现最佳生理起搏。
Six transition patterns and seven capture types in different left bundle branch bipolar pacing configurations
AimsThis study aims to explore the different transition patterns and capture types during two bipolar pacing tests based on the selective left bundle branch (LBB) capture determined by the continuous pacing and recording technique.MethodsIn total, 67 patients completed two unipolar and two bipolar pacing tests based on selective LBB capture during screwing-in for left bundle branch pacing (LBBP) using the continuous pacing and recording technique. The electrophysiological characteristics and potential mechanisms of different pacing configurations were further evaluated in this study.ResultsWe found six transition patterns and derived seven capture types in two bipolar pacing tests according to the analysis of continuous electrocardiogram and electrogram changes. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + right ventricular septum pacing (RVSP)” capture type.ConclusionsIn this study, we observed for the first time that “Ring−Tip+” bipolar pacing allows for a lower clinically applicable pacing threshold for simultaneous capture of the LBB and left and right ventricular septum myocardium, and the peculiar “LBBP + RVSP” capture type. This may be a more advantageous physiological pacing configuration, warranting further investigation and application in the future.Lay summaryBased on the specific selective LBB capture, we first found six transition patterns and derived seven capture types in two bipolar pacing tests due to the different thresholds of the LBB, left ventricular septal myocardial, and right ventricular septal myocardial. Compared with the conventional configuration of “Tip−Ring+” bipolar pacing, “Ring−Tip+” testing had a lower threshold for simultaneous capture of the LBB and the left and right ventricular septum myocardium (1.57 vs. 2.84 V at 0.5 ms) and was the only configuration to yield the peculiar “LBBP + RVSP” capture type. More pacing strategies should be released and investigated to achieve the best physiological pacing according to the individualized electrophysiological characteristics of patients.
期刊介绍:
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.