Effect of left bundle branch pacing on electrocardiogram in patients with right bundle branch block

doi:10.3877/cma.j.issn.2095-6568.2022.03.008

Abstract

Abstract:

Objective

To investigate the electrocardiographic effects of left bundle branch pacing (LBBP) in symptomatic bradycardia patients with intrinsic complete right bundle branch block (RBBB).

Methods

All of the patients with symptomatic bradycardia and intrinsic complete RBBB were consecutively enrolled from January 2019 to December 2021, attempting to do LBBP in the Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University. In the standard 12-lead electro cardiogram, QRS morphology in lead V₁, QRS duration, delayed right ventricular activation time (dRVAT), left ventricular activation time (LVAT) and inter-ventricular conduction delay (IVD) were documented and compared between before and after LBBP respectively.

Results

A total of 53 patients were included, (72.15±9.39)years old, and 34 of them were male. Forty-six of them underwent LBBP successfully. The QRS morphology was primarily rsR' pattern (83%) before LBBP, whereas the QRS morphology of LBBP was mainly Qr pattern (29/46,63%). When compared to pre-procedure, LBBP significantly reduced the QRS duration [(149.09±12.81) ms vs. (112.46±9.64) ms, P<0.001], fully corrected the QRS duration in 76.08%,(35/463) of cases, partially corrected in 21.73%(10/46), and uncorrected in 2.17%(1/46), and improved IVD [(58.28±12.54) ms vs. (34.34±8.87) ms, P<0.001], but increased LVAT [(42.46±6.95) ms vs. (66.53±10.83) ms, P<0.001]. There was no significant difference in dRVAT [(100.47±12.40) ms vs. (100.86±10.57) ms, P=0.955].

Conclusion

LBBP can reduce the QRS duration of intrinsic complete RBBB, improve the interventricular electrical synchronization, and present a Qr-dominated pattern in lead V₁.

Key words: Pacemaker, artificial, Left bundle branch, Right bundle branch block, Electrocardiogram

Kailun Zhu, Linlin Li, Guiyang Li, Jianghai Liu, Dong Chang, Qiang Li. Effect of left bundle branch pacing on electrocardiogram in patients with right bundle branch block[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(03): 165-170.

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Figures/Tables 5

项目	数值
年龄（岁， $x ¯ ± s$ ）	72.15±9.39
男性［例（%）］	34（64）
心率（次/min， $x ¯ ± s$ ）	50.75±14.09
起搏器指征［例（%）］
高度房室传导阻滞	41（77）
病态窦房结综合征	11（21）
心房颤动伴长RR间期	1（2）
起搏参数（ $x ¯ ± s$ ）
阈值（V）	0.58±0.18
感知（mV）	13.20±4.82
阻抗（Ω）	713.12±158.01

项目	数值
年龄（岁， $x ¯ ± s$ ）	72.15±9.39
男性［例（%）］	34（64）
心率（次/min， $x ¯ ± s$ ）	50.75±14.09
起搏器指征［例（%）］
高度房室传导阻滞	41（77）
病态窦房结综合征	11（21）
心房颤动伴长RR间期	1（2）
起搏参数（ $x ¯ ± s$ ）
阈值（V）	0.58±0.18
感知（mV）	13.20±4.82
阻抗（Ω）	713.12±158.01

	QRS时限	dRVAT	LVAT	IVD
术前	149.09±12.81	100.47±12.40	42.46±6.95	58.28±12.54
术后	112.46±9.64	100.86±10.57	66.53±10.83	34.34±8.87
P值	<0.001	0.955	<0.001	<0.001

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