Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications

Aims In this study, we investigated the characteristics and underlying mechanisms of the electrocardiographic (ECG) morphology during left bundle branch area pacing (LBBAP), which have not been systematically described. Methods Patients with indications for permanent cardiac pacing underwent LBBAP a...

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Published in:Pacing and clinical electrophysiology 2020-03, Vol.43 (3), p.297-307
Main Authors: Gao, Ming‐Yang, Tian, Ying, Shi, Liang, Wang, Yan‐Jiang, Xie, Bo‐Qia, Qi, Jie, Zeng, Li‐Jun, Li, Xue‐Xun, Yang, Xin‐Chun, Liu, Xing‐Peng
Format: Article
Language:English
Subjects:
Aged
Bundle-Branch Block - physiopathology
Bundle-Branch Block - therapy
Cardiac Pacing, Artificial
Conduction
Electrocardiogram
electrocardiographic morphology
Electrocardiography
Female
Humans
left bundle branch area pacing
Male
Morphology
physiological pacing
Prospective Studies
right bundle branch block
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Summary:Aims In this study, we investigated the characteristics and underlying mechanisms of the electrocardiographic (ECG) morphology during left bundle branch area pacing (LBBAP), which have not been systematically described. Methods Patients with indications for permanent cardiac pacing underwent LBBAP attempts. The ECGs of patients with confirmed left bundle branch (LBB) capture were compared with those of individuals with right bundle branch block (RBBB) on 12‐lead ECG. Intracardiac electrograms recorded during implantation were analyzed in all patients who underwent pacing. Results LBBAP was successfully achieved in 87.5% (56/64) of patients. The QRS morphologies in lead V1 during LBBAP, which typically demonstrated Qr (60.7%), qR (19.6%), rSR’ (7.1%), or QS (12.5%) patterns, differed from those of native RBBB, which featured rsR’ (57.5%), M shape (23.7%), or monophasic R patterns (18.7%). The terminal R' wave duration in lead V1 was significantly shorter during LBBAP than during native RBBB (51 ± 12 ms vs 85 ± 19 ms, p 
ISSN:0147-8389
1540-8159
DOI:10.1111/pace.13884