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Is the pacing site closer to the left ventricular septal endocardium in left bundle branch pacing or in left ventricular septal pacing?

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Distinguishing between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) is challenging. This study aimed to compare the echocardiographic distance from the pacing lead tip to the left ventricular (LV) septal endocardium between patients who underwent LBBP and those who underwent LVSP successfully.

Methods

Fifty-nine consecutive patients (age 71.9 ± 12.0 years, 35.6% male) with traditional indications for permanent cardiac pacing were included (LBBP group, n = 46; LVSP group, n = 13). Unipolar pacing from the final pacing sites generated narrow QRS complexes with a right bundle branch block pattern in all patients. After the procedure, a physician blinded to the group allocation performed echocardiographic measurements of the distance between the lead tip and the LV septal endocardium.

Results

The mean paced QRS duration was comparable between the LBBP group and the LVSP group (105.3 ± 15.6 ms vs. 109.2 ± 9.6 ms, P = 0.287). In the LBBP group, the interval from the left bundle branch potential to QRS onset was 28.7 ± 9.0 ms. During diastole, the mean distance between the lead tip and the LV septal endocardium was 0.6 ± 0.9 mm in the LBBP group and 3.0 ± 1.6 mm in the LVSP group (P < 0.001). During systole, the distance was 1.5 ± 1.4 mm in the LBBP group and 4.3 ± 2.6 mm in the LVSP group (P < 0.001).

Conclusions

The landing zone of the lead tip was closer to the LV septal endocardium in the patients who underwent LBBP. There is a need for real-time intraprocedural monitoring of the distance between the lead tip and the LV septal endocardium when performing LBBP.

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Data Availability

Data are available from the corresponding author upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

AVB:

Atrioventricular block

ECG:

Electrocardiography

EGM:

Electrogram

HBP:

His bundle pacing

LAO30°:

Left anterior oblique 30°

LBB:

Left bundle branch

LBBB:

Left bundle branch block

LBBP:

Left bundle branch pacing

LV:

Left ventricular

LVAT:

Left ventricular activation time

LVEDd:

Left ventricular end-diastolic dimension

LVEF:

Left ventricular ejection fraction

LVESd:

Left ventricular end-systolic dimension

LVSP:

Left ventricular septal pacing

MR:

Mitral regurgitation

RAO30°:

Right anterior oblique 30°

RBBB:

Right bundle branch block

RV:

Right ventricular

Stim-LVAT:

Stimulus to left ventricular activation time (interval from stimulus to LV activation)

TR:

Tricuspid regurgitation

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Funding

This study was supported by grants from Beijing Natural Science Foundation (Grant No. 7202050).

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Author notes

  1. Xin-Yi Peng, Yan-Jiang Wang, and Lan-Lan Sun contributed equally to this work.

Authors and Affiliations

  1. Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China

    Xin-Yi Peng, Yan-Jiang Wang, Liang Shi, Chao-Di Cheng, Li-Hong Huang, Ying Tian & Xing-Peng Liu

  2. Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China

    Lan-Lan Sun

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  1. Xin-Yi Peng
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Contributions

Concept/design: Xing-Peng Liu. Data collection: Xin-Yi Peng, Yan-Jiang Wang, Lan-Lan Sun. Procedure performing: Xing-Peng Liu, Ying Tian, Liang Shi, Yan-Jiang Wang. Data analysis/interpretation: Xin-Yi Peng, Chao-Di Cheng, Li-Hong Huang. Drafting article: Xin-Yi Peng. Critical revision of the article: Xing-Peng Liu, Ying Tian. Approval of article, statistics: Ying Tian. Funding secured by: Xing-Peng Liu.

Corresponding authors

Correspondence to Ying Tian or Xing-Peng Liu.

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Ethics approval and consent to participate

Each participant has agreed to be included in this research by giving written or oral informed consent. The scope and methods of this study were approved by the Ethics Committee of Beijing Chaoyang Hospital before patients were included.

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The authors declare no competing interests.

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Peng, XY., Wang, YJ., Sun, LL. et al. Is the pacing site closer to the left ventricular septal endocardium in left bundle branch pacing or in left ventricular septal pacing?. J Interv Card Electrophysiol 66, 539–549 (2023). https://doi.org/10.1007/s10840-022-01143-x

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  • DOI: https://doi.org/10.1007/s10840-022-01143-x

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