open access

Online first
Original article
Published online: 2022-04-05
Get Citation

Recording an isoelectric interval as an endpoint of left bundle branch pacing with continuous paced intracardiac electrogram monitoring

Hao Wu1, Longfu Jiang1, Jiabo Shen1
DOI: 10.33963/KP.a2022.0094
·
Pubmed: 35380007
Affiliations
  1. Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China

open access

Online first
Original article
Published online: 2022-04-05

Abstract

Abstract

Background: The present study aimed to evaluate the feasibility and safety of the novel left bundle branch pacing (LBBP) procedure that uses isoelectric interval as an endpoint for lead implantation.

Methods: A total of 41 patients with indications for pacing were enrolled. All patients underwent a novel LBBP procedure guided by recording an isoelectric interval as an endpoint for lead implantation. The procedural details and  electrophysiological characteristics were then analyzed.

Results: A total of 38/41 (92.7%) cases were confirmed of LBB capture. An isoelectric interval was observed in 36/41 cases (87.8%). A total of 36/41 (87.8%) cases with LBB potential were observed. The mean unipolar LBBP threshold at the implant was 0.5 ± 0.2 V. The mean sensed amplitude of the R wave and the pacing impedance at the implant were 12.9 ± 5.0 mV and 723.5 ± 117.1 Ω. During the final threshold testing, a transition from non-selective to selective LBBP (S-LBBP) was demonstrated in 26 patients. A transition from non-selective LBBP (NS-LBBP) to left ventricular septal myocardial capture was observed in 12 patients.

Conclusion: Using an isoelectric interval as an endpoint to guide the LBBP was feasible in a high proportion of captured LBB cases.

Abstract

Abstract

Background: The present study aimed to evaluate the feasibility and safety of the novel left bundle branch pacing (LBBP) procedure that uses isoelectric interval as an endpoint for lead implantation.

Methods: A total of 41 patients with indications for pacing were enrolled. All patients underwent a novel LBBP procedure guided by recording an isoelectric interval as an endpoint for lead implantation. The procedural details and  electrophysiological characteristics were then analyzed.

Results: A total of 38/41 (92.7%) cases were confirmed of LBB capture. An isoelectric interval was observed in 36/41 cases (87.8%). A total of 36/41 (87.8%) cases with LBB potential were observed. The mean unipolar LBBP threshold at the implant was 0.5 ± 0.2 V. The mean sensed amplitude of the R wave and the pacing impedance at the implant were 12.9 ± 5.0 mV and 723.5 ± 117.1 Ω. During the final threshold testing, a transition from non-selective to selective LBBP (S-LBBP) was demonstrated in 26 patients. A transition from non-selective LBBP (NS-LBBP) to left ventricular septal myocardial capture was observed in 12 patients.

Conclusion: Using an isoelectric interval as an endpoint to guide the LBBP was feasible in a high proportion of captured LBB cases.

Get Citation

Keywords

conduction system pacing, isoelectric interval, intracardiac electrogram, john jiang’s connecting cable, left bundle branch pacing

Supp./Additional Files (2)
Supplementary material, Video S1
Download
20MB
Supplementary material, Video S2
Download
37MB
About this article
Title

Recording an isoelectric interval as an endpoint of left bundle branch pacing with continuous paced intracardiac electrogram monitoring

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-04-05

Page views

116

Article views/downloads

75

DOI

10.33963/KP.a2022.0094

Pubmed

35380007

Keywords

conduction system pacing
isoelectric interval
intracardiac electrogram
john jiang’s connecting cable
left bundle branch pacing

Authors

Hao Wu
Longfu Jiang
Jiabo Shen

References (17)
  1. Mafi-Rad M, Luermans JG, Blaauw Y, et al. Feasibility and acute hemodynamic effect of left ventricular septal pacing by transvenous approach through the interventricular septum. Circ Arrhythm Electrophysiol. 2016; 9(3): e003344.
  2. Huang W, Chen X, Su L, et al. A beginner's guide to permanent left bundle branch pacing. Heart Rhythm. 2019; 16(12): 1791–1796.
  3. Vijayaraman P, Subzposh FA, Naperkowski A, et al. Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm. 2019; 16(12): 1774–1782.
  4. Huang W, Su L, Wu S, et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017; 33(12): 1736.e1–1736.e3.
  5. Chen K, Li Y, Dai Y, et al. Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy. Europace. 2019; 21(4): 673–680.
  6. Li X, Li H, Ma W, et al. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect. Heart Rhythm. 2019; 16(12): 1766–1773.
  7. Jastrzębski M, Kiełbasa G, Moskal P, et al. Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation. Heart Rhythm. 2021; 18(4): 562–569.
  8. Jastrzębski M, Moskal P, Bednarek A, et al. First Polish experience with permanent direct pacing of the left bundle branch. Kardiol Pol. 2019; 77(5): 580–581.
  9. Jastrzębski M, Moskal P. Reaching the left bundle branch pacing area within 36 heartbeats. Kardiol Pol. 2021; 79(5): 587–588.
  10. Jiang F, Jiang L. Left bundle branch pacing with dynamic retrograde His bundle potential and intracardiac isoelectric interval: A case report. HeartRhythm Case Rep. 2021; 7(8): 553–557.
  11. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2019; 16(9): e128–e226.
  12. Randhawa A, Gupta T, Aggarwal A, et al. Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts. Cardiovasc Pathol. 2017; 30: 38–44.
  13. Ponnusamy SS, Vijayaraman P. How to implant his bundle and left bundle pacing leads: tips and pearls. Card Fail Rev. 2021; 7: e13.
  14. Jastrzębski M, Burri H, Kiełbasa G, et al. The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture. Europace. 2022; 24(1): 40–47.
  15. Shimeno K, Tamura S, Nakatsuji K, et al. Characteristics and proposed mechanisms of QRS morphology observed during the left bundle branch pacing procedure. Pacing Clin Electrophysiol. 2021; 44(12): 1987–1994.
  16. Upadhyay GA, Cherian T, Shatz DY, et al. Intracardiac delineation of septal conduction in left bundle-branch block patterns. Circulation. 2019; 139(16): 1876–1888.
  17. Wu S, Chen X, Wang S, et al. Evaluation of the criteria to distinguish left bundle branch pacing from left ventricular septal pacing. JACC Clin Electrophysiol. 2021; 7(9): 1166–1177.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl