Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing

Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing

Abstract Aims To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure...

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Veröffentlicht in:Europace (London, England) England), 2023-06, Vol.25 (6)
Hauptverfasser: Pujol-López, Margarida, Ferró, Elisenda, Borràs, Roger, Garre, Paz, Guasch, Eduard, Jiménez-Arjona, Rafael, Garcia-Ribas, Cora, Doltra, Adelina, Niebla, Mireia, Carro, Esther, Roca-Luque, Ivo, Guichard, J Baptiste, Puente, J Luis, Uribe, Laura, Vázquez-Calvo, Sara, Castel, M Ángeles, Arbelo, Elena, Porta-Sánchez, Andreu, Sitges, Marta, Tolosana, José M, Mont, Lluís
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Bundle of His
Bundle-Branch Block - diagnosis
Bundle-Branch Block - therapy
Cardiac Pacing, Artificial - methods
Cardiac Resynchronization Therapy - methods
Clinical Research
Electrocardiography - methods
Heart Conduction System
Humans
Treatment Outcome
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container_title Europace (London, England)
container_volume 25
creator Pujol-López, Margarida
Ferró, Elisenda
Borràs, Roger
Garre, Paz
Guasch, Eduard
Jiménez-Arjona, Rafael
Garcia-Ribas, Cora
Doltra, Adelina
Niebla, Mireia
Carro, Esther
Roca-Luque, Ivo
Guichard, J Baptiste
Puente, J Luis
Uribe, Laura
Vázquez-Calvo, Sara
Castel, M Ángeles
Arbelo, Elena
Porta-Sánchez, Andreu
Sitges, Marta
Tolosana, José M
Mont, Lluís
description Abstract Aims To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking. Methods and results A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R
doi_str_mv 10.1093/europace/euad128
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Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking. Methods and results A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R &lt;80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP. Conclusion Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract). Graphical Abstract Graphical abstract Electrocardiographic- and electrogram-based stepwise approach for electrical resynchronization with left bundle branch pacing. QRS should be measured from the start of fast deflection in left bundle branch capture Plus (QRS ≤120 ms).</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euad128</identifier><identifier>PMID: 37294671</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Bundle of His ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - therapy ; Cardiac Pacing, Artificial - methods ; Cardiac Resynchronization Therapy - methods ; Clinical Research ; Electrocardiography - methods ; Heart Conduction System ; Humans ; Treatment Outcome</subject><ispartof>Europace (London, England), 2023-06, Vol.25 (6)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. 2023</rights><rights>The Author(s) 2023. 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Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking. Methods and results A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R &lt;80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP. Conclusion Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract). Graphical Abstract Graphical abstract Electrocardiographic- and electrogram-based stepwise approach for electrical resynchronization with left bundle branch pacing. QRS should be measured from the start of fast deflection in left bundle branch capture Plus (QRS ≤120 ms).</description><subject>Bundle of His</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiac Resynchronization Therapy - methods</subject><subject>Clinical Research</subject><subject>Electrocardiography - methods</subject><subject>Heart Conduction System</subject><subject>Humans</subject><subject>Treatment Outcome</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFkcFrFDEUh4MotrbePUmOgoy-JDOZyUlkqVUo9NDeQybzZjeSTcYkY6kn__RGdlv05Ok9yPf78uBHyBsGHxgo8RHXFBdjsS5mYnx4Rk5ZJ3jDQfHndQelmo5xdUJe5fwdAHquupfkRNTZyp6dkt83BZc7l5GaZfHOmuJioHGmF5tLasJE0aMtKW6T2TejyThRm1zB5AwtkWLIa8IjVNOeJsz3we5SDO7XQXbnyo56nAsd1zB5pGMylaD1cBe25-TFbHzG18d5Rm6_XNxuvjZX15ffNp-vGtsKUZpxhr6TaAeOHaDiamaAY6t6abGbZzUKq1oBfSsQoQMjUTIpEfjQKzkycUY-HbTLOu5xshhKMl4vye1NutfROP3vS3A7vY0_NQPetdCLanh3NKT4Y8Vc9N5li96bgHHNmg-8lYpDO1QUDqhNMeeE89M_DPSf4vRjcfpYXI28_fu-p8BjUxV4fwDiuvxf9wBB5Kpk</recordid><startdate>20230602</startdate><enddate>20230602</enddate><creator>Pujol-López, Margarida</creator><creator>Ferró, Elisenda</creator><creator>Borràs, Roger</creator><creator>Garre, Paz</creator><creator>Guasch, Eduard</creator><creator>Jiménez-Arjona, Rafael</creator><creator>Garcia-Ribas, Cora</creator><creator>Doltra, Adelina</creator><creator>Niebla, Mireia</creator><creator>Carro, Esther</creator><creator>Roca-Luque, Ivo</creator><creator>Guichard, J Baptiste</creator><creator>Puente, J Luis</creator><creator>Uribe, Laura</creator><creator>Vázquez-Calvo, Sara</creator><creator>Castel, M Ángeles</creator><creator>Arbelo, Elena</creator><creator>Porta-Sánchez, Andreu</creator><creator>Sitges, Marta</creator><creator>Tolosana, José M</creator><creator>Mont, Lluís</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3539-6917</orcidid><orcidid>https://orcid.org/0000-0003-2797-2590</orcidid><orcidid>https://orcid.org/0000-0002-5887-6326</orcidid><orcidid>https://orcid.org/0000-0003-3510-1488</orcidid><orcidid>https://orcid.org/0000-0003-1300-4732</orcidid><orcidid>https://orcid.org/0000-0003-4723-0551</orcidid><orcidid>https://orcid.org/0000-0003-0424-6393</orcidid><orcidid>https://orcid.org/0000-0002-8115-5906</orcidid><orcidid>https://orcid.org/0000-0003-0191-2776</orcidid><orcidid>https://orcid.org/0000-0003-4238-5319</orcidid><orcidid>https://orcid.org/0000-0002-4523-6469</orcidid><orcidid>https://orcid.org/0000-0002-8585-2522</orcidid><orcidid>https://orcid.org/0000-0003-0731-3731</orcidid><orcidid>https://orcid.org/0000-0002-1215-3472</orcidid><orcidid>https://orcid.org/0000-0002-2613-2920</orcidid><orcidid>https://orcid.org/0000-0002-3589-7597</orcidid><orcidid>https://orcid.org/0000-0002-4696-7722</orcidid></search><sort><creationdate>20230602</creationdate><title>Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing</title><author>Pujol-López, Margarida ; Ferró, Elisenda ; Borràs, Roger ; Garre, Paz ; Guasch, Eduard ; Jiménez-Arjona, Rafael ; Garcia-Ribas, Cora ; Doltra, Adelina ; Niebla, Mireia ; Carro, Esther ; Roca-Luque, Ivo ; Guichard, J Baptiste ; Puente, J Luis ; Uribe, Laura ; Vázquez-Calvo, Sara ; Castel, M Ángeles ; Arbelo, Elena ; Porta-Sánchez, Andreu ; Sitges, Marta ; Tolosana, José M ; Mont, Lluís</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-bf0756ec82e50e929f10eb4976ce5ff9b3c9430743ee050a6e6166e028796b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bundle of His</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiac Resynchronization Therapy - methods</topic><topic>Clinical Research</topic><topic>Electrocardiography - methods</topic><topic>Heart Conduction System</topic><topic>Humans</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pujol-López, Margarida</creatorcontrib><creatorcontrib>Ferró, Elisenda</creatorcontrib><creatorcontrib>Borràs, Roger</creatorcontrib><creatorcontrib>Garre, Paz</creatorcontrib><creatorcontrib>Guasch, Eduard</creatorcontrib><creatorcontrib>Jiménez-Arjona, Rafael</creatorcontrib><creatorcontrib>Garcia-Ribas, Cora</creatorcontrib><creatorcontrib>Doltra, Adelina</creatorcontrib><creatorcontrib>Niebla, Mireia</creatorcontrib><creatorcontrib>Carro, Esther</creatorcontrib><creatorcontrib>Roca-Luque, Ivo</creatorcontrib><creatorcontrib>Guichard, J Baptiste</creatorcontrib><creatorcontrib>Puente, J Luis</creatorcontrib><creatorcontrib>Uribe, Laura</creatorcontrib><creatorcontrib>Vázquez-Calvo, Sara</creatorcontrib><creatorcontrib>Castel, M Ángeles</creatorcontrib><creatorcontrib>Arbelo, Elena</creatorcontrib><creatorcontrib>Porta-Sánchez, Andreu</creatorcontrib><creatorcontrib>Sitges, Marta</creatorcontrib><creatorcontrib>Tolosana, José M</creatorcontrib><creatorcontrib>Mont, Lluís</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pujol-López, Margarida</au><au>Ferró, Elisenda</au><au>Borràs, Roger</au><au>Garre, Paz</au><au>Guasch, Eduard</au><au>Jiménez-Arjona, Rafael</au><au>Garcia-Ribas, Cora</au><au>Doltra, Adelina</au><au>Niebla, Mireia</au><au>Carro, Esther</au><au>Roca-Luque, Ivo</au><au>Guichard, J Baptiste</au><au>Puente, J Luis</au><au>Uribe, Laura</au><au>Vázquez-Calvo, Sara</au><au>Castel, M Ángeles</au><au>Arbelo, Elena</au><au>Porta-Sánchez, Andreu</au><au>Sitges, Marta</au><au>Tolosana, José M</au><au>Mont, Lluís</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2023-06-02</date><risdate>2023</risdate><volume>25</volume><issue>6</issue><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract Aims To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking. Methods and results A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R &lt;80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP. Conclusion Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract). Graphical Abstract Graphical abstract Electrocardiographic- and electrogram-based stepwise approach for electrical resynchronization with left bundle branch pacing. 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source MEDLINE; Oxford Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection
subjects Bundle of His
Bundle-Branch Block - diagnosis
Bundle-Branch Block - therapy
Cardiac Pacing, Artificial - methods
Cardiac Resynchronization Therapy - methods
Clinical Research
Electrocardiography - methods
Heart Conduction System
Humans
Treatment Outcome
title Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing
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