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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 |
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| container_issue | 3 |
| container_start_page | 297 |
| container_title | Pacing and clinical electrophysiology |
| container_volume | 43 |
| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1111/pace.13884 |
| format | article |
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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 < 0.001). LBB potentials were recorded in 66.1% (37/56) of the LBBAP patients. No significant differences in ECG characteristics were found between LBBAP with and without recorded LBB potentials. The presence of bundle branch block during LBBAP significantly prolonged QRS duration, R wave peak time, and terminal R’ wave duration in lead V1.
Conclusion
LBBAP‐ECG patterns are characterized by a shorter terminal R’ wave duration in lead V1 compared with that of native RBBB configurations. Bundle branch conduction integrity has an impact on ECG characteristics during LBBAP.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.13884</identifier><identifier>PMID: 32045008</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Pacing and clinical electrophysiology, 2020-03, Vol.43 (3), p.297-307</ispartof><rights>2020 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3574-78b45c9002b82a7e3d3b5c1a5346149ed537d753ee8cb80f24f0939203c47d113</citedby><cites>FETCH-LOGICAL-c3574-78b45c9002b82a7e3d3b5c1a5346149ed537d753ee8cb80f24f0939203c47d113</cites><orcidid>0000-0002-8304-7909 ; 0000-0002-6690-1114</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32045008$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gao, Ming‐Yang</creatorcontrib><creatorcontrib>Tian, Ying</creatorcontrib><creatorcontrib>Shi, Liang</creatorcontrib><creatorcontrib>Wang, Yan‐Jiang</creatorcontrib><creatorcontrib>Xie, Bo‐Qia</creatorcontrib><creatorcontrib>Qi, Jie</creatorcontrib><creatorcontrib>Zeng, Li‐Jun</creatorcontrib><creatorcontrib>Li, Xue‐Xun</creatorcontrib><creatorcontrib>Yang, Xin‐Chun</creatorcontrib><creatorcontrib>Liu, Xing‐Peng</creatorcontrib><title>Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>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 < 0.001). LBB potentials were recorded in 66.1% (37/56) of the LBBAP patients. No significant differences in ECG characteristics were found between LBBAP with and without recorded LBB potentials. The presence of bundle branch block during LBBAP significantly prolonged QRS duration, R wave peak time, and terminal R’ wave duration in lead V1.
Conclusion
LBBAP‐ECG patterns are characterized by a shorter terminal R’ wave duration in lead V1 compared with that of native RBBB configurations. Bundle branch conduction integrity has an impact on ECG characteristics during LBBAP.</description><subject>Aged</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Pacing, Artificial</subject><subject>Conduction</subject><subject>Electrocardiogram</subject><subject>electrocardiographic morphology</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Humans</subject><subject>left bundle branch area pacing</subject><subject>Male</subject><subject>Morphology</subject><subject>physiological pacing</subject><subject>Prospective Studies</subject><subject>right bundle branch block</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u3CAQxlHVqtkmveQBKqReoqpOwEDAvUWr7R8pUnJIzxaG8ZoIgwu2qn2DPHbYbNJDD-EyaOY334zmQ-iUknNa3sWkDZxTphR_g1ZUcFIpKpq3aEUol5ViqjlCH3K-J4RcEi7eoyNWl0iIWqGHjQczp2h0si5uk54GZ_AY0zREH7c7bJfkwhZ76GfcLcF6wF3SwQxYJ9C4zC7lb3g96KTNDMnl2Zn8FRcUkt_te0cwgw4ujyWtg8XGu-CM9tiNky-f2cWQT9C7XvsMH5_jMfr9fXO3_lld3_z4tb66rgwTkldSdVyYhpC6U7WWwCzrhKFaMH5JeQNWMGmlYADKdIr0Ne9Jw5qaMMOlpZQdo7OD7pTinwXy3I4uG_BeB4hLbmsmmFCUNbygn_9D7-OSQtmuUFLWdbmnLNSXA2VSzDlB307JjTrtWkravT_t3p_2yZ8Cf3qWXLoR7D_0xZAC0APw13nYvSLV3l6tNwfRRz8vnB8</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Gao, Ming‐Yang</creator><creator>Tian, Ying</creator><creator>Shi, Liang</creator><creator>Wang, Yan‐Jiang</creator><creator>Xie, Bo‐Qia</creator><creator>Qi, Jie</creator><creator>Zeng, Li‐Jun</creator><creator>Li, Xue‐Xun</creator><creator>Yang, Xin‐Chun</creator><creator>Liu, Xing‐Peng</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8304-7909</orcidid><orcidid>https://orcid.org/0000-0002-6690-1114</orcidid></search><sort><creationdate>202003</creationdate><title>Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3574-78b45c9002b82a7e3d3b5c1a5346149ed537d753ee8cb80f24f0939203c47d113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Pacing, Artificial</topic><topic>Conduction</topic><topic>Electrocardiogram</topic><topic>electrocardiographic morphology</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Humans</topic><topic>left bundle branch area pacing</topic><topic>Male</topic><topic>Morphology</topic><topic>physiological pacing</topic><topic>Prospective Studies</topic><topic>right bundle branch block</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gao, Ming‐Yang</creatorcontrib><creatorcontrib>Tian, Ying</creatorcontrib><creatorcontrib>Shi, Liang</creatorcontrib><creatorcontrib>Wang, Yan‐Jiang</creatorcontrib><creatorcontrib>Xie, Bo‐Qia</creatorcontrib><creatorcontrib>Qi, Jie</creatorcontrib><creatorcontrib>Zeng, Li‐Jun</creatorcontrib><creatorcontrib>Li, Xue‐Xun</creatorcontrib><creatorcontrib>Yang, Xin‐Chun</creatorcontrib><creatorcontrib>Liu, Xing‐Peng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gao, Ming‐Yang</au><au>Tian, Ying</au><au>Shi, Liang</au><au>Wang, Yan‐Jiang</au><au>Xie, Bo‐Qia</au><au>Qi, Jie</au><au>Zeng, Li‐Jun</au><au>Li, Xue‐Xun</au><au>Yang, Xin‐Chun</au><au>Liu, Xing‐Peng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2020-03</date><risdate>2020</risdate><volume>43</volume><issue>3</issue><spage>297</spage><epage>307</epage><pages>297-307</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>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 < 0.001). LBB potentials were recorded in 66.1% (37/56) of the LBBAP patients. No significant differences in ECG characteristics were found between LBBAP with and without recorded LBB potentials. The presence of bundle branch block during LBBAP significantly prolonged QRS duration, R wave peak time, and terminal R’ wave duration in lead V1.
Conclusion
LBBAP‐ECG patterns are characterized by a shorter terminal R’ wave duration in lead V1 compared with that of native RBBB configurations. Bundle branch conduction integrity has an impact on ECG characteristics during LBBAP.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32045008</pmid><doi>10.1111/pace.13884</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-8304-7909</orcidid><orcidid>https://orcid.org/0000-0002-6690-1114</orcidid></addata></record> |
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| ispartof | Pacing and clinical electrophysiology, 2020-03, Vol.43 (3), p.297-307 |
| issn | 0147-8389 1540-8159 |
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| source | SPORTDiscus database; Wiley-Blackwell Read & Publish Collection |
| 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 |
| title | Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications |
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