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. 2021 Sep;7(9):1166-1177.
doi: 10.1016/j.jacep.2021.02.018. Epub 2021 Apr 28.

Evaluation of the Criteria to Distinguish Left Bundle Branch Pacing From Left Ventricular Septal Pacing

Shengjie Wu  1 , Xueying Chen  2 , Songjie Wang  1 , Lei Xu  1 , Fangyi Xiao  1 , Zhouqing Huang  1 , Rujie Zheng  1 , Limeng Jiang  1 , Pugazhendhi Vijayaraman  3 , Parikshit S Sharma  4 , Lan Su  5 , Weijian Huang  6
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Free article

Evaluation of the Criteria to Distinguish Left Bundle Branch Pacing From Left Ventricular Septal Pacing

Shengjie Wu et al. JACC Clin Electrophysiol. 2021 Sep.
Free article

Abstract

Objectives: This study sought to assess the predictive value of the proposed electrocardiogram and intracardiac electrogram characteristics for confirmation of left bundle branch (LBB) capture.

Background: Previously proposed criteria to distinguish left bundle branch pacing (LBBP) and left ventricular septum (LVS) pacing (LVSP) have not been fully validated.

Methods: A His bundle pacing lead, an LBBP lead, and a multielectrode catheter at the LVS were placed. Direct LBB capture was defined as demonstration of retrograde His potential on the His bundle pacing lead and/or anterograde left conduction system potentials on the multielectrode catheter during LBBP. The routinely used parameters-His, LBB potential, time from stimulus to peak ventricular activation (Stim-LVAT), and paced QRS morphology during LVSP and LBBP at various depths and outputs were analyzed.

Results: Thirty patients (21 non-left bundle branch block [LBBB], 9 LBBB) who demonstrated direct LBB capture using the defined criteria were included. The proportion of paced right bundle branch block was 100% during LBB capture in all patients compared to 23.4% in non-LBBB and 44.4% in LBBB during LVSP. LBB potential was recorded in all patients during intrinsic rhythm (non-LBBB group) or His corrective pacing in LBBB. Paced QRS duration was longer during selective LBBP compared to nonselective LBBP or LVSP only. All patients with characteristics of selective LBBP or abrupt decrease in Stim-LVAT of ≥10 ms demonstrated LBB capture.

Conclusions: Direct LBB capture can be confirmed by recording retrograde His potential and anterograde left conduction system potentials. Abrupt decrease in Stim-LVAT of ≥10 ms and demonstration of selective LBBP could be used as simple criteria to confirm LBB capture.

Keywords: His bundle pacing; cardiac resynchronization therapy; criteria; left bundle branch; left bundle branch pacing; left ventricular septal pacing; time from stimulus to left ventricular activation.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Key Research and Development Program of Zhejiang (grant no. 2019C03012), Natural Science for Youth Foundation (grant no. 81900345), Major Project of the Science and Technology of Wenzhou (grant no. ZS2017010), and Clinical Research Plan of Shanghai Hospital Development Center (grant no. SHDC2020CR4003). Dr Vijayaraman has served as a speaker and consultant and has research and fellowship support from Medtronic; has served as a consultant for Abbott, Biotronik, Boston Scientific, and Eagelpoint LLC; and holds a patent for a His bundle pacing delivery tool. Dr Sharma has served as a speaker for Medtronic; and has served as a consultant for Medtronic, Abbott Medical, Boston Scientific, and Biotronik Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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