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Correlations between myocardial injury current and lead performance in His bundle pacing compared with left bundle branch area pacing and right ventricular septum pacing

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Conduction system pacing by implanting the lead in the His bundle (HBP) region or in the left bundle branch area (LBBAP) has gained popularity. Myocardial injury current (IC) is useful for predicting adequate lead fixation in right ventricular septal pacing (RVSP).

Objectives and methods

We compared the correlations between IC and lead performance among patients receiving HBP (n = 41), LBBAP (n = 53), and historical RVSP (n = 88). LBBAP was an alternative if optimal HBP was not achieved. A positive IC (STpost-screw-in − STpre-screw-in) was defined as > 0.2 mV or a > 25% ST elevation and prolongation of the ventricular electrograms > 10 ms from baseline.

Results

HBP patients with a positive IC (48%, 0.84 ± 0.4 V/0.4 ms) exhibited a similar pacing threshold to their LBBAP counterparts (76%, 0.75 ± 0.3 V/0.4 ms, p = 0.329), but a higher pacing threshold than their RVSP counterparts (67%, 0.50 ± 0.1 V/0.4 ms, p < 0.001) at implantation. The R-wave (5.70 ± 3.4 mV) and impedance (660.91 ± 140.8 Ω) were both lower than those of LBBAP (10.35 ± 6.0 mV, p = 0.002; 822.36 ± 235.8 Ω, p = 0.005) and RVSP (11.24 ± 4.9 mV, p < 0.001; 754.27 ± 126.4 Ω, p = 0.006) patients respectively at implantation. The trend of electrical parameter comparisons remained unchanged during follow-up (3.56 ± 1.4 months). Notably, HBP patients without ICs had a higher pacing threshold (1.24 ± 0.6 V/0.4 ms) compared to their LBBAP (0.73 ± 0.3 V/0.4 ms, p = 0.009) and RVSP (0.53 ± 0.1 V/0.4 ms, p < 0.001) counterparts at implantation and during follow-up.

Conclusions

The detection of positive changes of myocardial ICs during HBP was associated with a better capture threshold equivalent to the LBBAP counterpart both at implantation and during short-term follow-up. Further large-scale studies with longer follow-up are necessary to confirm these findings.

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Funding

This study was supported in part by the Taiwan Ministry of Science and Technology (MOST 111–2314-B-039–012, MOST 110–2314-B-039–050, and MOST 109–2314-B-039–045) and China Medical University Hospital (DMR-111–020 and DMR-110–012). None of these funding sources had a further role in the study design; collection, analysis, or interpretation of data; writing the report; or decision to submit the paper for publication.

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Author notes

  1. Wei-Hsin Chung and Hung-Pin Wu contributed equally to this study.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan

    Wei-Hsin Chung, Hung-Pin Wu, Yen-Nien Lin, Jan-Yow Chen, Kuo-Hung Lin & Kuan-Cheng Chang

  2. School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan

    Mei-Yao Wu

  3. Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan

    Mei-Yao Wu

  4. School of Medicine, China Medical University, Taichung, Taiwan

    Yen-Nien Lin & Kuan-Cheng Chang

  5. Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan

    Yen-Nien Lin & Kuan-Cheng Chang

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  1. Wei-Hsin Chung
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  2. Hung-Pin Wu
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Contributions

Conceptualization: WH Chung and KC Chang. Methodology: WH Chung, HP Wu, YN Lin, JY Chen, KH Lin, and KC Chang. Formal analysis and investigation: WH Chung, HP Wu, MY Wu, YN Lin, JY Chen, KH Lin, and KC Chang. Writing—original draft preparation: WH Chung and KC Chang. Writing—review and editing: WH Chung, MY Wu, and KC Chang. Funding acquisition: KC Chang. Resources: WH Chung, HP Wu, YN Lin, JY Chen, KH Lin, and KC Chang. Supervision: KC Chang.

Corresponding author

Correspondence to Kuan-Cheng Chang.

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Ethics approval

The study protocol was reviewed and approved by the Research Ethics Committee of each center with the joint analysis center at China Medical University Hospital (CMUH110-REC2-114).

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Not applicable.

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The authors declare no competing interests.

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Chung, WH., Wu, HP., Wu, MY. et al. Correlations between myocardial injury current and lead performance in His bundle pacing compared with left bundle branch area pacing and right ventricular septum pacing. J Interv Card Electrophysiol 66, 1349–1358 (2023). https://doi.org/10.1007/s10840-022-01385-9

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  • DOI: https://doi.org/10.1007/s10840-022-01385-9

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