Application of continuous pacing recording technique in left bundle branch pacing: electrophysiological characteristics of pacing at different septal depth

doi:10.3877/cma.j.issn.2095-6568.2024.02.006

Abstract

Abstract:

Objective

To identify various pacing modalities of different interventricular septum and evaluate their electrophysiological characteristics using continuous pacing and recording technique.

Methods

All of the patients with symptomatic bradycardia were consecutively enrolled from April 2021 to September 2023, and attempted to do left bundle branch (LBB) pacing (LBBP) in Ningbo No.2 Hospital using continuous pacing and recording technique. In the standard 12-lead electrocardiogram and intracardiac electrocardiogram, stimulus to V₆ R wave peak time (Stim-V6RWPT), stimulus to V₁ R wave peak time, stimulus to QRS end duration (Stim-QRSd), and V₆-V₁ interpeak were documented and compared during implantation, which was divided into right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP1 and IVSP2), left ventricular septal pacing (LVSP), non-selective LBBP (NSLBBP), and selective LBBP (SLBBP).

Results

Eighty-three point four percent (201/241) patients with six pacing modality transitions were included, (74.1±9.7) years old, and 115 (57.2%, 115/201) of them were male. The Stim-V6RWPT of NSLBBP and SLBBP were significantly shorter than RVSP, IVSP1 and IVSP2 [(68.8 ± 8.7) ms vs. (68.3 ± 8.8) ms vs. (104.5±10.3) ms, vs. (90.6±13.0) ms, vs. (82.2 ± 10.3) ms, P＜0.001]. Stim-QRSd was the narrowest in IVSP2 [(134.3 ± 14.8) ms] instead of NSLBBP [(137.4 ± 16.4) ms].

Conclusion

It is feasible to distinguish various pacing modalities at different interventricular septum using uninterrupted pacing technique. Electrophysiological evidence from our study shows that the characteristics of these six pacing modalities are different, especially LBBP and LVSP. Therefore, LBBP and LVSP should not be brought under the LBB area pacing umbrella.

Key words: Cardiac pacing,artificial, Left bundle branch pacing, Left ventricular septal pacing, Intraventricular septal pacing, Continuous pacing technique

Jiabo Shen, Longfu Jiang, Hao Wu, Hengdong Li, Lu Zhang, Jinyan Zhong, Shanshan Zhuo, Nan Zheng, Yuelin Zhang. Application of continuous pacing recording technique in left bundle branch pacing: electrophysiological characteristics of pacing at different septal depth[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2024, 12(02): 102-112.

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Figures/Tables 7

项目	数值
例数	201
年龄（岁， $x ¯ ± s$ ）	74.1±9.7
男性［例（%）］	115（57.2）
起搏器适应证［例（%）］
房室传导阻滞	139（69.2）
病态窦房结综合征	55（27.4）
心房颤动伴长RR间期	9（4.4）
心力衰竭	7（3.5）
合并疾病［例（%）］
高血压	127（63.2）
糖尿病	53（26.4）
心肌病	9（4.5）
冠心病	27（13.4）
心房颤动	54（26.9）
左心室射血分数（%， $x ¯ ± s$ ）	63.1±10.1
左心室舒张末期内径（mm， $x ¯ ± s$ ）	49.6±7.2
QRS波形态［例（%）］
窄QRS波	136（67.6）
右束支传导阻滞	35（17.4）
左束支传导阻滞	30（14.9）
非特异性室内传导延迟	4（2.0）

项目	数值
例数	201
年龄（岁， $x ¯ ± s$ ）	74.1±9.7
男性［例（%）］	115（57.2）
起搏器适应证［例（%）］
房室传导阻滞	139（69.2）
病态窦房结综合征	55（27.4）
心房颤动伴长RR间期	9（4.4）
心力衰竭	7（3.5）
合并疾病［例（%）］
高血压	127（63.2）
糖尿病	53（26.4）
心肌病	9（4.5）
冠心病	27（13.4）
心房颤动	54（26.9）
左心室射血分数（%， $x ¯ ± s$ ）	63.1±10.1
左心室舒张末期内径（mm， $x ¯ ± s$ ）	49.6±7.2
QRS波形态［例（%）］
窄QRS波	136（67.6）
右束支传导阻滞	35（17.4）
左束支传导阻滞	30（14.9）
非特异性室内传导延迟	4（2.0）

项目	数值
例数	201
Po_LBB发生率［例（%）］	139（69.2）
Po_LBB-V间期（ms， $x ¯ ± s$ ）	25.1±8.2
Po_LBB-V6RWPT（ms， $x ¯ ± s$ ）	63.8±8.3
Po_LBB 振幅［mV，M（Q₁，Q₃）］	0.2（0.1，0.4）
Stim-V6RWPT缩短时间（ms， $x ¯ ± s$ ）	14.7±5.5
初始LBB夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.8±0.5
初始LVS夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	1.3±0.9
初始心室感知（mV， $x ¯ ± s$ ）	8.1±3.8
初始阻抗（Ω， $x ¯ ± s$ ）	780.5±165.9
最终LBB夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.6±0.5
最终LVS夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.7±0.3
最终心室感知（mV， $x ¯ ± s$ ）	15.3±6.8
最终阻抗（Ω， $x ¯ ± s$ ）	728.4±127.7
电极深度（mm， $x ¯ ± s$ ）	14.9±2.9
穿孔发生率［例（%）］	10（4.9）

项目	数值
例数	201
Po_LBB发生率［例（%）］	139（69.2）
Po_LBB-V间期（ms， $x ¯ ± s$ ）	25.1±8.2
Po_LBB-V6RWPT（ms， $x ¯ ± s$ ）	63.8±8.3
Po_LBB 振幅［mV，M（Q₁，Q₃）］	0.2（0.1，0.4）
Stim-V6RWPT缩短时间（ms， $x ¯ ± s$ ）	14.7±5.5
初始LBB夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.8±0.5
初始LVS夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	1.3±0.9
初始心室感知（mV， $x ¯ ± s$ ）	8.1±3.8
初始阻抗（Ω， $x ¯ ± s$ ）	780.5±165.9
最终LBB夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.6±0.5
最终LVS夺获阈值（V/0.5 ms， $x ¯ ± s$ ）	0.7±0.3
最终心室感知（mV， $x ¯ ± s$ ）	15.3±6.8
最终阻抗（Ω， $x ¯ ± s$ ）	728.4±127.7
电极深度（mm， $x ¯ ± s$ ）	14.9±2.9
穿孔发生率［例（%）］	10（4.9）

项目	RVSP	IVSP1	IVSP2	LVSP	NSLBBP	SLBBP
例数	201	201	201	201	201	201
Stim-V6RWPT（ms， $x ¯ ± s$ ）	104.5±15.0	90.6±13.0	85.4±11.8	82.2±10.3	68.8±8.7	68.3±8.8
Stim-V1RWPT（ms， $x ¯ ± s$ ）	NA	NA	106.8±12.4	113.7±12.5	110.2±13.7	119.7±17.3
V₆-V₁峰间期（ms， $x ¯ ± s$ ）	NA	NA	21.0±8.8	32.2±11.2	42.6±12.1	51.5±15.4
Stim-QRSd（ms， $x ¯ ± s$ ）	148.2±16.4	135.2±15.1	134.3±14.8	139.5±15.1	137.4±16.4	148.7±19.5

项目	RVSP	IVSP1	IVSP2	LVSP	NSLBBP	SLBBP
例数	201	201	201	201	201	201
Stim-V6RWPT（ms， $x ¯ ± s$ ）	104.5±15.0	90.6±13.0	85.4±11.8	82.2±10.3	68.8±8.7	68.3±8.8
Stim-V1RWPT（ms， $x ¯ ± s$ ）	NA	NA	106.8±12.4	113.7±12.5	110.2±13.7	119.7±17.3
V₆-V₁峰间期（ms， $x ¯ ± s$ ）	NA	NA	21.0±8.8	32.2±11.2	42.6±12.1	51.5±15.4
Stim-QRSd（ms， $x ¯ ± s$ ）	148.2±16.4	135.2±15.1	134.3±14.8	139.5±15.1	137.4±16.4	148.7±19.5

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