High-pass filter settings and the role and mechanism of discrete ventricular electrograms in left bundle branch pacing

Abstract

ObjectiveThe characteristics of discrete intracardiac electrogram (EGM) in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete local ventricular components in an intracardiac EGM and to analyze its possible mechanisms.MethodsThis study included 144 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings (30, 60, 100, and 200 Hz) with a low-pass filter at 500 Hz, and their possible mechanisms were analyzed.ResultsLBBP was successfully achieved in 91.0% (131/144) of patients. SLBBP was achieved in 123 patients. The occurrence rates of discrete local ventricular EGM were 16.7, 33.3, 72.9, and 85.4% for HPF settings of 30, 60, 100, and 200 Hz, respectively. The analysis of discrete EGM detection showed significant differences between the different HPF settings. By using the discrete local ventricular component and isoelectric interval as the SLBB capture golden standard, the results of EGMs revealed that the 30 Hz HPF has a sensitivity of 19% and specificity of 100%. The 60 Hz HPF had a sensitivity of 39% and a specificity of 100%. The 100 Hz HPF had a sensitivity of 85% and a specificity of 100%. The 200 Hz HPF had a sensitivity of 100% and specificity of 100%.ConclusionAn optimal HPF setting of 200 Hz is recommended for discrete local ventricular EGM detection. A discrete local ventricular EGM should exhibit an isoelectric interval. A steep deflection and high-frequency ventricular EGM morphology nearly identify an intrinsic EGM morphology.

Electrophysiological characteristics of lead-position-dependent EGM uninterrupted transition during left bundle branch pacing

“…A filtered unipolar ventricular electrogram was obtained with high- and low-pass filter settings of 200 and 500 Hz to monitor the discrete EGM transition. [14] Unfiltered ventricular current of injury (COI) was monitored from the tip lead with band-pass filter settings of 0.5 and 500 Hz using a unipolar configuration during lead rotation. [15] The ventricular COI manifests as an increase in the duration and elevation of the ventricular electrogram compared to the baseline ( Figure 2 ).…”

Comparison of electrophysiological left bundle branch pacing characteristics in different bilateral electrode pacing vector configurations

“…The continuous LBBP pacing technique was utilized as described previously. [14][15][16] Patients with direct evidence of LBB capture obtained during dynamic electrocardiogram (ECG) maneuvers as a demonstration of non-selective LBB to selective LBB capture or non-selective LBB to septal capture transition during unipolar pacing threshold testing were included in the study to ensure data accuracy.…”