Differentiating Left Bundle Branch Pacing and Left Ventricular Septal Pacing: An Algorithm Based on Intracardiac Electrophysiology

2022 ◽  
Author(s):  
Xing Chen ◽  
Zhiyong Qian ◽  
Fengwei Zou ◽  
Yao Wang ◽  
Xinwei Zhang ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Septal Pacing

scholarly journals Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 822
Author(s):  
Luuk I.B. Heckman ◽  
Justin G.L.M. Luermans ◽  
Karol Curila ◽  
Antonius M.W. Van Stipdonk ◽  
Sjoerd Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Activation Time ◽  
Ventricular Synchrony ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
The Right ◽  
Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

scholarly journals Different lead locations guided by fluoroscopy and ECG parameters and their effect on patients functional status

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Mohamed MesbahTahaHassanin ◽  
Ahmad ShafieAmmar ◽  
Radwa M. Abdullah ◽  
Mohammad Hassan Khedr
Keyword(s):  
Functional Capacity ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Qrs Complex ◽  
Significant Difference ◽  
Septal Pacing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Right ventricular apical pacing with the resultant left ventricular dyssynchrony often leads to depressed systolic function and heart failure. This study aimed at investigating the relation between various septal locations guided by ECG and fluoroscopy and the intermediate term functional capacity of the patients. Results Fifty patients who received a single lead pacemaker with assumed > 90% pacemaker dependency. Patients were randomized according to RV pacing site RV into group 1 “high septum” (n = 15), group 2 “mid septum” (n = 25), and group 3 “low septum” (n = 10) using QRS vector and duration as well as fluoroscopic parameters. Their clinical status was assessed 6 months after device implementation using 6-min walk test (6MWT). The study showed that paced QRS complex duration itself has no significant difference between the different septal pacing locations (P-value 0.675), although its combination with the paced QRS complex vector can signify the optimal pacing site and 6MWT showed a significant difference among the groups in favor of group 1; group 1 (413.3 ± 148.5), group 2 (359.8 ± 124.6), and group 3 (276.0 ± 98.5) P value 0.04. Conclusion There was a significant difference found between the three septal pacing sites concerning the patient functional capacity with superiority of high septal location. By contrast, different septal sites showed no significant difference of the paced QRS complex duration. To optimize the pacing site in the septum, assessment of the paced QRS vector in leads I and III is of a great benefit especially when combined with paced QRS complex duration assessment.

scholarly journals Right Ventricular Septal Pacing Preserves Global Left Ventricular Longitudinal Function in Comparison With Apical Pacing

2011 ◽  
Vol 75 (7) ◽  
pp. 1609-1615 ◽  
Author(s):  
Katsuji Inoue ◽  
Hideki Okayama ◽  
Kazuhisa Nishimura ◽  
Makoto Saito ◽  
Toyofumi Yoshii ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular ◽  
Global Left Ventricular ◽  
Longitudinal Function ◽  
Septal Pacing

scholarly journals B-PO04-033 THE PACING SITE IS CLOSER TO THE LEFT VENTRICULAR SEPTAL ENDOCARDIUM DURING LEFT BUNDLE BRANCH PACING THAN DURING LEFT VENTRICULAR SEPTAL PACING

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S292-S293
Author(s):  
Xinyi Peng ◽  
Yanjiang Wang ◽  
Liang Shi ◽  
Chaodi Cheng ◽  
Lihong Huang ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Septal Pacing

scholarly journals A new integrated approach to improve left ventricular electromechanical activation during right ventricular septal pacing

EP Europace ◽  
2011 ◽  
Vol 14 (1) ◽  
pp. 92-98 ◽  
Author(s):  
G. Pastore ◽  
S. Aggio ◽  
E. Baracca ◽  
G. Rigatelli ◽  
F. Zanon ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Integrated Approach ◽  
Left Ventricular ◽  
Septal Pacing

Abstract 2163: Single-site Left Ventricular Apex And Left Ventricular Septal Pacing For Long Term Maintenance Of Cardiac Contractility

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Robert W Mills ◽  
Larry J Mulligan ◽  
Arne van Hunnik ◽  
Marion Kuiper ◽  
Anniek Lampert ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Single Site ◽  
Lv Function ◽  
Atrial Pacing ◽  
Septal Pacing ◽  
To Receive ◽  
Ventricular Conduction

Objective: Conventional right ventricular (RV) apex pacing is associated with asynchronous activation and reduced left ventricular (LV) pump function. Previous studies have shown acute hemodynamic benefits over RV apex pacing by LV septal or LV apex pacing. We investigated whether this improvement translates into a long-term benefit and how acute LV function during single site LV pacing compares to biventricular pacing. Methods: After AV-nodal ablation, mongrel dogs were randomized to receive 16 weeks of VDD pacing at the RV apex (n = 7), LV apex (n = 7), or LV mid-septum (n = 8; trans-ventricular septal approach). LV contractility (dP/dt max /P instantaneous ) was measured during normal ventricular conduction from atrial pacing (AP) and during ventricular pacing 1–3 hours and 16 weeks after implant. At 16 weeks, contractility was also measured after an acute switch from the implant site (IS) to the non-implanted apex (both for LV septal group) and to RV apex + LV lateral (BiV) pacing. Results: While acute and chronic RV apex pacing significantly reduced contractility (Figure a ; mean ± SD, *p<0.05 contrasted to 1), LV pacing maintained contractility near AP levels. After 16 weeks of RV apex pacing, switching to LV apex pacing (but not BiV pacing) increased contractility (Figure b ). After 16 weeks of LV pacing, switching to RV apex pacing decreased contractility. Collectively, acute LV apex pacing enhanced contractility over acute BiV (p<.001). Conclusions: Chronic LV apex and LV mid-septal pacing maintain contractility near normal levels, and at a higher level than RV apex pacing. Acutely, LV apex pacing improves contractility compared to BiV pacing.

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