Journal
EUROPACE
Volume 24, Issue 1, Pages 40-47Publisher
OXFORD UNIV PRESS
DOI: 10.1093/europace/euab164
Keywords
Left bundle branch pacing; Left bundle branch capture; Left ventricular septal capture; Conduction system pacing; Electrocardiogram
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The V-6-V-1 interpeak interval in ECG during left bundle branch (LBB) area pacing can differentiate between different types of LBB capture, showing potential for clinical use in diagnosing LBB capture.
Aims We hypothesized that during left bundle branch (LBB) area pacing, the various possible combinations of direct capture/non-capture of the septal myocardium and the LBB result in distinct patterns of right and left ventricular activation. This could translate into different combinations of R-wave peak time (RWPT) in V-1 and V-6. Consequently, the V-6-V-1 interpeak interval could differentiate the three types of LBB area capture: non-selective (ns-)LBB, selective (s-)LBB, and left ventricular septal (LVS). Methods and results Patients with unquestionable evidence of LBB capture were included. The V-6-V-1 interpeak interval, V6RWPT, and V1RWPT were compared between different types of LBB area capture. A total of 468 patients from two centres were screened, with 124 patients (239 electrocardiograms) included in the analysis. Loss of LVS capture resulted in an increase in V1RWPT by >= 15 ms but did not impact V6RWPT. Loss of LBB capture resulted in an increase in V6RWPT by >= 15 ms but only minimally influenced V1RWPT. Consequently, the V-6-V-1 interval was longest during s-LBB capture (62.3 +/- 21.4 ms), intermediate during ns-LBB capture (41.3 +/- 14.0 ms), and shortest during LVS capture (26.5 +/- 8.6 ms). The optimal value of the V-6-V-1 interval value for the differentiation between ns-LBB and LVS capture was 33 ms (area under the receiver operating characteristic curve of 84.7%). A specificity of 100% for the diagnosis of LBB capture was obtained with a cut-off value of >44 ms. Conclusion The V-6-V-1 interpeak interval is a promising novel criterion for the diagnosis of LBB area capture.
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