Criteria for differentiating left bundle branch pacing and left ventricular septal pacing: A systematic review

Abstract

BackgroundAs a novel physiological pacing technique, left bundle branch pacing (LBBP) can preserve the left ventricular (LV) electrical and mechanical synchronization by directly capturing left bundle branch (LBB). Approximately 60–90% of LBBP were confirmed to have captured LBB during implantation, implying that up to one-third of LBBP is actually left ventricular septal pacing (LVSP). LBB capture is critical for distinguishing LBBP from LVSP.Methods and resultsA total of 15 articles were included in the analysis by searching PubMed, EMBASE, Web of Science, and the Cochrane Library database till August 2022. Comparisons of paced QRS duration between LVSP and LBBP have not been uniformly concluded, but the stimulus artifact to LV activation time in lead V5 or V6 (Stim-LVAT) was shorter in LBBP than LVSP in all studies. Stim-LVAT was used to determine LBB capture with a sensitivity of 76–95.2% and specificity of 78.8–100%, which varied across patient populations.ConclusionThe output-dependent QRS transition from non-selective LBBP to selective LBBP or LVSP is direct evidence of LBB capture. LBB potential combined with short Stim-LVAT can predict LBB capture better. Personalized criteria rather than a fixed value of Stim-LVAT are necessary to confirm LBB capture in different populations, especially in patients with LBB block or heart failure.

Comparison of Depolarization and Repolarization Parameters in Left vs. Right Ventricular Septal Pacing—An Intraprocedural Electrocardiographic Study

“…Lead advancement was stopped when ventricular premature beats with a right bundle branch block morphology (RBBB) appeared on the 12-lead ECG. Successful LBBAP was defined according to the commonly used criteria in the literature as a paced QRS complex from the distal electrode of RBBB morphology and one of the following: a recorded left bundle branch potential, a left ventricular activation time less than 80 ms for baseline narrow QRS, and less than 90 ms for baseline wide QRS complex or proof of transition from nonselective to selective pacing with decreasing pacing amplitude [ 12 ].…”

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

“…[ 36 , 37 ] However, when compared with LBB pacing, LVSP has been associated with significantly longer left ventricular activation time in V5-V6 and longer paced QRS durations. [ 33 , 38 ] Consequently, this could potentially lead to a decrease in LV synchrony. [ 39 ] In patients with HF, LBB pacing was associated with a significant reduction in the composite outcome of HF-related hospitalisation and all-cause mortality compared with LVSP (Cox proportional HR: 0.36, 95% CI [0.197–0.654]; p=0.001).…”

A shorter R wave peak time in left bundle branch pacing may not be a marker of more physiological ventricular activation: A case report

“…1 LBBp captures the left bundle branch (LBB) in the lower and stable output and maintains the physiological left ventricular stimulation sequence during pacing. 2 However, the specific conduction bundle that dominates the left ventricular activation remains controversial. In this case, we show that the left anterior fascicle (LAF) stimulates initial left ventricular activation and that LAF pacing has a shorter R-wave peak time (RWPT).…”

“…Compared to traditional right ventricular pacing, the His‐Purkinje conduction system, including His‐bundle pacing and left bundle branch pacing (LBBp), has been confirmed to have better electrical synchronicity and clinical benefits 1 . LBBp captures the left bundle branch (LBB) in the lower and stable output and maintains the physiological left ventricular stimulation sequence during pacing 2 . However, the specific conduction bundle that dominates the left ventricular activation remains controversial.…”