Left bundle branch pacing with and without anodal capture: impact on ventricular activation pattern and acute haemodynamics.

Autor:	Ali N; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Saqi K; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Arnold AD; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Miyazawa AA; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Keene D; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Chow JJ; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Little I; Medtronic Limited, Watford, UK., Peters NS; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Kanagaratnam P; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Qureshi N; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Ng FS; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Linton NWF; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Lefroy DC; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Francis DP; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Boon Lim P; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Tanner MA; St Richard's Hospital, University Hospitals Sussex NHS Foundation Trust, Watford, UK., Muthumala A; St Bartholomew's Hospital and North Middlesex University Hospital, Watford, UK., Agarwal G; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Shun-Shin MJ; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Cole GD; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK., Whinnett ZI; National Heart and Lung Institute-Cardiovascular Science, The Hammersmith Hospital, Imperial College London, B-Block South, 2nd Floor, Du Cane Road, London W12 0NN, UK.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Oct 05; Vol. 25 (10).
DOI:	10.1093/europace/euad264
Abstrakt:	Aims: Left bundle branch pacing (LBBP) can deliver physiological left ventricular activation, but typically at the cost of delayed right ventricular (RV) activation. Right ventricular activation can be advanced through anodal capture, but there is uncertainty regarding the mechanism by which this is achieved, and it is not known whether this produces haemodynamic benefit. Methods and Results: We recruited patients with LBBP leads in whom anodal capture eliminated the terminal R-wave in lead V1. Ventricular activation pattern, timing, and high-precision acute haemodynamic response were studied during LBBP with and without anodal capture. We recruited 21 patients with a mean age of 67 years, of whom 14 were males. We measured electrocardiogram timings and haemodynamics in all patients, and in 16, we also performed non-invasive mapping. Ventricular epicardial propagation maps demonstrated that RV septal myocardial capture, rather than right bundle capture, was the mechanism for earlier RV activation. With anodal capture, QRS duration and total ventricular activation times were shorter (116 ± 12 vs. 129 ± 14 ms, P < 0.01 and 83 ± 18 vs. 90 ± 15 ms, P = 0.01). This required higher outputs (3.6 ± 1.9 vs. 0.6 ± 0.2 V, P < 0.01) but without additional haemodynamic benefit (mean difference -0.2 ± 3.8 mmHg compared with pacing without anodal capture, P = 0.2). Conclusion: Left bundle branch pacing with anodal capture advances RV activation by stimulating the RV septal myocardium. However, this requires higher outputs and does not improve acute haemodynamics. Aiming for anodal capture may therefore not be necessary. Competing Interests: Conflict of interest: none declared. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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