Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Dec;22(12):3218-3227.
doi: 10.1016/j.hrthm.2025.03.1959. Epub 2025 Mar 17.

Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing

Johan van Koll  1 , Justin G L M Luermans  2 , Jacqueline Joza  3 , Haran Burri  4 , Karol Curila  5 , Edoardo Bressi  6 , Domenico Grieco  6 , Sander M J van Kuijk  2 , Jesse H J Rijks  2 , Antonius M W van Stipdonk  2 , Karin C Smits  7 , Frits W Prinzen  7 , Leonard M Rademakers  8 , Kevin Vernooy  2 , Uyên Châu Nguyên  9
Affiliations
Free article
Multicenter Study

Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing

Johan van Koll et al. Heart Rhythm. 2025 Dec.
Free article

Abstract

Background: Determining capture type and septal lead location during left bundle branch area pacing (LBBAP) relies on criteria obtained during implantation. However, during follow-up, the interpretation of left bundle branch (LBB) capture largely depends on QRS morphology, which is not so straightforward in LBBAP.

Objective: This study aimed to investigate the inter- and intraobserver agreement, as well as the accuracy of clinical judgment of the electrocardiogram (ECG) in determining LBB-capture and septal lead position in patients undergoing LBBAP implantation. In addition, the role of vectorcardiographic QRS-area in determining LBB-capture was evaluated.

Methods: Unipolar paced ECGs during LBBAP implantation from 50 patients with baseline narrow QRS were collected. LBB-capture was attempted in all patients and assessed using MELOS (Multicentre European Left Bundle Branch Area Pacing Outcomes Study) criteria and the European Heart Rhythm Association (EHRA) consensus statement. Eight blinded cardiologists classified 100 ECGs for capture type and septal location.

Results: The interobserver and intraobserver agreement for capture type had a Light's kappa of 0.43 and 0.62, respectively. Concordance between clinical judgment and intraprocedural confirmation averaged 72%. Interobserver and intraobserver agreement for septal lead position had a Light's kappa of 0.43 and 0.77 respectively. QRS-area was significantly higher for left ventricular septal pacing (LVSP) than nsLBBP, whereas QRS duration was not. A QRS-area cutoff of 26 mV.ms had 77% accuracy in distinguishing LVSP from nsLBBP. Clinical judgment accuracy averaged 72%.

Conclusion: Interobserver agreement and correlation with intraprocedural confirmation (gold standard) are only moderate, whereas intraobserver agreement on ECG-based differentiation of capture type and septal lead location is substantial. Vectorcardiographic QRS-area slightly outperforms clinical judgment in distinguishing capture types and may be a useful objective alternative.

Keywords: Capture type; Conduction system pacing; Interobserver and intraobserver agreement; Left bundle branch area pacing; Vectorcardiography.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Luermans has received a research grant and consultancy agreement with Medtronic (all grants are paid to the institute). Dr Burri has received honoraria from Abbott, Biotronik, Medtronic, and Microport, paid to the institution. Dr Curila is cofounder of the commercial version of the UHF-ECG system (VDI technologies), filed an US patent number US 11,517,243B2: “Method of electrocardiographic signal processing and apparatus for performing the method” and is shareholder of the company VDI Technologies, Inc. Dr Prinzen has received research grants from Medtronic, Abbott, MicroPort CRM, and Biotronik. Dr Smits has been supported by a grant from the Dutch Heart Foundation (2021-T016). Dr Rademakers has a consultancy agreement with Medtronic and has been supported by grants from the Dutch Heart Foundation (2024-0477). Dr Vernooy has received research and educational grants and consultancy agreements with Medtronic, Abbott, Boston Scientific, Microport, Philips, and Biosense Webster (all grants are paid to the institute).

Publication types

LinkOut - more resources