Left bundle branch pacing shortened the QRS duration of a right bundle branch block

Zhu, Kailun; Lin, Manxin; Li, Linlin; Chang, Dong; Li, Qiang

doi:10.1016/j.jelectrocard.2021.08.018

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…Gao et al (19) compared the ECG characteristics of LBBP to those of intrinsic RBBB, and discovered that the majority of the QRS morphology in lead V1 of LBBP showed a Qr pattern, whereas the majority of intrinsic RBBB showed a rsR' pattern. Furthermore, they described an RBBB patient who completed SLBBP with the same terminal R' wave duration of 76 ms as the intrinsic, but which reduced to 58 ms as output increased, suggesting that NSLBBP could compensate for RV delay by capturing a portion of cardiomyocytes, which is consistent with the findings of the other studies (22,23). According to Li et al (15), 8 atrioventricular block (AVB) patients with RBBB completed LBBP, with five RBBB corrected successfully by bipolar LBBP at a low output or unipolar pacing at relatively high output.…”

Section: Left Bundle Branch Pacing In Right Bundle Branch Block Patientssupporting

confidence: 75%

The Physiologic Mechanisms of Paced QRS Narrowing During Left Bundle Branch Pacing in Right Bundle Branch Block Patients

Zhu

Sun

Lin

et al. 2022

Front. Cardiovasc. Med.

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Left bundle branch pacing (LBBP) is a physiological pacing technique that captures the left bundle branch (LBB) directly, causing the left ventricle (LV) to be excited earlier than the right ventricle (RV), resulting in a “iatrogenic” right bundle branch block (RBBB) pacing pattern. Several studies have recently shown that permanent LBBP can completely or partially narrow the wide QRS duration of the intrinsic RBBB in most patients with bradycardia, although the mechanisms by which this occurs has not been thoroughly investigated. This article presents a review of the LBBP in patients with intrinsic RBBB mentioned in current case reports and clinical studies, discussing the technique, possible mechanisms, future clinical explorations, and the feasibility of eliminating the interventricular dyssynchronization accompanied with LBBP.

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Section: Left Bundle Branch Pacing In Right Bundle Branch Block Patientssupporting

confidence: 75%

The Physiologic Mechanisms of Paced QRS Narrowing During Left Bundle Branch Pacing in Right Bundle Branch Block Patients

Zhu

Sun

Lin

et al. 2022

Front. Cardiovasc. Med.

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“…Shimeno et al also revealed that the terminal R′/r′ wave duration of LBBP with bipolar pacing configuration is shorter than that of LVSP, presumably due to the contribution of the anodal capture during bipolar pacing ( 17 ). In addition, some previous studies and case reports have shown that LBBP can shorten the QRS duration of intrinsic RBBB or even completely correct RBBB ( 19 – 23 ), while LVSP cannot, but the underlying mechanism remains unclear and needs further study.…”

Section: Comparison Of Lbbp and Lvsp In Interventricular Synchronymentioning

confidence: 96%

Which Is More Likely to Achieve Cardiac Synchronization: Left Bundle Branch Pacing or Left Ventricular Septal Pacing?

Zhu

Chang

2022

Front. Cardiovasc. Med.

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“…Although many studies have been devoted to demonstrating the efficacy of (s/ns)LBBP and LVSP, most of the current work is focused on electrophysiological parameters, such as QRS duration, 7 , 8 QRS area 9 , 10 and LV–RV activation times. 11 Currently, it is not clear how and to what extent these electrophysiological indices relate to cardiac pump function or local myocardial mechanics, even though local mechanics are the likely driver of (reverse) remodelling.…”

Section: Introductionmentioning

confidence: 99%

Comparison of novel ventricular pacing strategies using an electro-mechanical simulation platform

et al. 2023

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Aims Focus of pacemaker therapy is shifting from right ventricular (RV) apex pacing (RVAP) and biventricular pacing (BiVP) to conduction system pacing. Direct comparison between the different pacing modalities and their consequences to cardiac pump function is difficult, due to the practical implications and confounding variables. Computational modelling and simulation provide the opportunity to compare electrical, mechanical, and haemodynamic consequences in the same virtual heart. Methods and results Using the same single cardiac geometry, electrical activation maps following the different pacing strategies were calculated using an Eikonal model on a three-dimensional geometry, which were then used as input for a lumped mechanical and haemodynamic model (CircAdapt). We then compared simulated strain, regional myocardial work, and haemodynamic function for each pacing strategy. Selective His-bundle pacing (HBP) best replicated physiological electrical activation and led to the most homogeneous mechanical behaviour. Selective left bundle branch (LBB) pacing led to good left ventricular (LV) function but significantly increased RV load. RV activation times were reduced in non-selective LBB pacing (nsLBBP), reducing RV load but increasing heterogeneity in LV contraction. LV septal pacing led to a slower LV and more heterogeneous LV activation than nsLBBP, while RV activation was similar. BiVP led to a synchronous LV–RV, but resulted in a heterogeneous contraction. RVAP led to the slowest and most heterogeneous contraction. Haemodynamic differences were small compared to differences in local wall behaviour. Conclusion Using a computational modelling framework, we investigated the mechanical and haemodynamic outcome of the prevailing pacing strategies in hearts with normal electrical and mechanical function. For this class of patients, nsLBBP was the best compromise between LV and RV function if HBP is not possible.

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Left bundle branch pacing shortened the QRS duration of a right bundle branch block

Cited by 7 publications

References 6 publications

The Physiologic Mechanisms of Paced QRS Narrowing During Left Bundle Branch Pacing in Right Bundle Branch Block Patients

The Physiologic Mechanisms of Paced QRS Narrowing During Left Bundle Branch Pacing in Right Bundle Branch Block Patients

Which Is More Likely to Achieve Cardiac Synchronization: Left Bundle Branch Pacing or Left Ventricular Septal Pacing?

Comparison of novel ventricular pacing strategies using an electro-mechanical simulation platform

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