The characteristics of the electrocardiogram and the intracardiac electrogram in left bundle branch pacing
The characteristics of the electrocardiogram and the intracardiac electrogram in left bundle branch pacing
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DOI：
10.1111/jce.13956
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发表时间：
2019-07-01
影响因子：
2.7
通讯作者：
Huang, Weijian
中科院分区：
文献类型：
--
作者：
Chen, Xueying;Wu, Shengjie;Huang, Weijian
前言左束支起搏(LBBP)能以低而稳定的阈值维持左心室电同步性。然而，LBBP的心电图定义还没有很好地确立。本文报告四例LBBP的心电图和心内电(EGM)特征。方法与结果4例患者，其中房室传导阻滞(AVB)2例，左束支传导阻滞(LBBB)2例。在不同的起搏输出量下进行LBBP，收集ECG和EGM，并进行比较。选择性下体负压(S-下体负压)被定义为在EGM中仅捕捉到具有典型红斑部结构且起搏刺激和心室激动之间存在分离成分的下体部位。而非选择性LBBP(NS-LBBP)可同时捕获LBB和局部心肌，形成无离散成分的狭窄右束支传导阻滞(RBBB)形态。2例在狭窄的QRS波群或选择性希氏束起搏矫正左束支时记录左束支电位，获得左束支电位(n=3)。在不同的起搏输出量下，LBBP获得恒定且最短的左心室激活时间(LVAT)刺激。结论LBBP的心电图和EGM特征可概括为：1)RBBB型；2)常伴有LBB电位；3)SLBBP有特殊的心电图改变，EGM呈离散成分；4)在不同的起搏输出量时，对LVAT的刺激是恒定和最短的。需要进一步的研究来证实这些观察结果。
Introduction Left bundle branch pacing (LBBP) has recently been reported to maintain left ventricular electrical synchrony with a low and stable threshold. However, the electrocardiogram (ECG) definitions of LBBP have not been well established. We report four cases to show the characteristics of the ECG and the intracardiac electrogram (EGM) in LBBP. Methods and Results Four patients, two with an atrioventricular block (AVB) and two with left bundle branch block (LBBB), were included in the study. LBBP was performed and the ECGs and EGMs were collected and compared at different pacing outputs. Selective LBBP (S-LBBP) was defined as only capturing the LBB with a typical RBBB morphology and a discrete component between the pacing stimulus and ventricular activation in the EGMs. While nonselective LBBP (NS-LBBP) captured both the LBB and the local myocardium, resulting in a narrow right bundle branch block (RBBB) morphology without the discrete component. The left bundle branch (LBB) potential was recorded in two cases during narrow QRS complex or LBBB correction by selective His bundle pacing and SLBBP (n = 3) was achieved. A constant and shortest stimulus to left ventricular activation time (LVAT) in LBBP was obtained at different pacing outputs. Conclusion The ECG and EGM characteristics of LBBP can be summarized as: 1) RBBB pattern; 2) usually with the LBB potential; 3) SLBBP with specific ECG changes and a discrete component in EGM; and 4) with a constant and shortest stimulus to LVAT at different pacing outputs. Further studies are necessary to confirm these observations.