Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing.

Autor:	Curila K; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Jurak P; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic., Prinzen F; Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands., Jastrzebski M; First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland., Waldauf P; Department of Anesthesia and Intensive Care, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Halamek J; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic., Tothova M; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Znojilova L; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Smisek R; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.; Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic., Kach J; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Poviser L; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Linkova H; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Plesinger F; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic., Moskal P; First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland., Viscor I; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic., Vondra V; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic., Leinveber P; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic., Osmancik P; Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Mar 22; Vol. 10, pp. 1140988. Date of Electronic Publication: 2023 Mar 22 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1140988
Abstrakt:	Background: Left bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. Methods: In patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: aLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean -9 ms; 95% CI (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. aLBBP resulted in e-DYS -9 ms (-12; -6) vs. e-DYS 10 ms (7;14), p < 0.001 during HBP. Local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). Conclusion: Although aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP. Competing Interests: Authors from the Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, from Institute of Scientific Instruments, the Czech Academy of Sciences, and from the International Clinical Research Center, St. Anne’s University Hospital have filed a European patent application EP 19212534.2: “Method of electrocardiographic signal processing and apparatus for performing the method.” and are shareholders of the company VDI technologies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer [KV] declared a shared parent affiliation with the author [FWP] to the handling editor at the time of review. (© 2023 Curila, Jurak, Prinzen, Jastrzebski, Waldauf, Halamek, Tothova, Znojilova, Smisek, Kach, Poviser, Linkova, Plesinger, Moskal, Viscor, Vondra, Leinveber and Osmancik.)
Databáze:	MEDLINE
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