{"title":"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）。","authors":"Shunmuga Sundaram Ponnusamy MD, DM, CEPS-A , Vithiya Ganesan MD , Vadivelu Ramalingam MD, DM , Saravana Kumar BSc , Ramvivek Ramamoorthy MBBS , Kishore Ramu MBBS , Vaishnavi Nagarajan Bhuvaneshwari MBBS , Devisree Selvaraj MBBS , Avanthika Swisi Alagar MBBS , Jananie Dhanapal MBBS , Ranjitha Selvaraj MBBS , Mariann Diana MBBS , Selvaganesh Mariappan MD, DM , Senthil Murugan MD, DNB , Mahesh Kumar MD, DM , Pugazhendhi Vijayaraman MD, FHRS","doi":"10.1016/j.hrthm.2024.10.049","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>The aim of the study was to analyze the electrophysiologic characteristics of RV activation by mapping the RBB during LBBAP and its clinical correlation.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 8","pages":"Pages e407-e415"},"PeriodicalIF":7.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Electrophysiologic characteristics and clinical correlation of right ventricular activation during left bundle branch area pacing (RV-LBBAP study)\",\"authors\":\"Shunmuga Sundaram Ponnusamy MD, DM, CEPS-A , Vithiya Ganesan MD , Vadivelu Ramalingam MD, DM , Saravana Kumar BSc , Ramvivek Ramamoorthy MBBS , Kishore Ramu MBBS , Vaishnavi Nagarajan Bhuvaneshwari MBBS , Devisree Selvaraj MBBS , Avanthika Swisi Alagar MBBS , Jananie Dhanapal MBBS , Ranjitha Selvaraj MBBS , Mariann Diana MBBS , Selvaganesh Mariappan MD, DM , Senthil Murugan MD, DNB , Mahesh Kumar MD, DM , Pugazhendhi Vijayaraman MD, FHRS\",\"doi\":\"10.1016/j.hrthm.2024.10.049\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>The aim of the study was to analyze the electrophysiologic characteristics of RV activation by mapping the RBB during LBBAP and its clinical correlation.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\"22 8\",\"pages\":\"Pages e407-e415\"},\"PeriodicalIF\":7.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1547527124035100\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527124035100","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Electrophysiologic characteristics and clinical correlation of right ventricular activation during left bundle branch area pacing (RV-LBBAP study)
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.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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