A MacGyvering way to left bundle branch area pacing: Using the modified V1/V6 leads connected to the pacing system analyzer

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-02-01 DOI:10.1016/j.hroo.2024.11.021

Sanjai Pattu Valappil MD, DM , Krishnaswamy Subramanyan MD, DM , Pramod Jaiswal MD, DM , Krishnan Jayanthi MD, DNB , Golla N. Prasad MD, DNB , Tirupattur S. Srinath MD, DNB , Shilpa Menon MD, DM , Sharan Shreedhar MD , Uma Sirisha Pusapati MBBS , Abhinav B. Anand MD, DM

{"title":"A MacGyvering way to left bundle branch area pacing: Using the modified V1/V6 leads connected to the pacing system analyzer","authors":"Sanjai Pattu Valappil MD, DM , Krishnaswamy Subramanyan MD, DM , Pramod Jaiswal MD, DM , Krishnan Jayanthi MD, DNB , Golla N. Prasad MD, DNB , Tirupattur S. Srinath MD, DNB , Shilpa Menon MD, DM , Sharan Shreedhar MD , Uma Sirisha Pusapati MBBS , Abhinav B. Anand MD, DM","doi":"10.1016/j.hroo.2024.11.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>There is a significant impediment to the availability of a fully capable electrophysiology (EP) procedure room and EP recording system due to healthcare cost restraints in resource-poor settings.</div></div><div><h3>Objective</h3><div>The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test machine 12-lead ECG system and modified V1 and V6 leads connected to the pacing system analyzer (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP).</div></div><div><h3>Methods</h3><div>LBBaP was attempted by a single operator using the Medtronic 3830 lumenless leads and St. Jude/Abbott stylet-driven leads in a mixed cohort of patients at hospitals lacking an EP recording system. Conduction system capture was assessed using modified V1 and V6 leads.</div></div><div><h3>Results</h3><div>LBBaP was successful in 18 (94.7%) of 19 patients. There was excellent correlation between 12-lead ECG and modified V1 and V6 leads connected to the PSA regarding the measurement of V6 left ventricular activation time and QRS morphology change in V1 during selective to nonselective left bundle branch capture. Patient characteristics were the following: mean age of 66.7 ± 11.47 years, 52.63% male, 10.52% with ischemic cardiomyopathy, and 5.26% with nonischemic cardiomyopathy. LBBaP resulted in a QRS duration of 112.77 ±11.27 ms with a left ventricular activation time of 70.55 ± 8.02 ms. Left ventricular ejection fraction improved in the patients with cardiomyopathy from 33.4 ± 5.77% to 48.2 ± 12.37% (<em>P</em> = .028).</div></div><div><h3>Conclusion</h3><div>The modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful LLBaP.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 237-241"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart Rhythm O2","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266650182400391X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

There is a significant impediment to the availability of a fully capable electrophysiology (EP) procedure room and EP recording system due to healthcare cost restraints in resource-poor settings.

Objective

The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test machine 12-lead ECG system and modified V1 and V6 leads connected to the pacing system analyzer (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP).

Methods

LBBaP was attempted by a single operator using the Medtronic 3830 lumenless leads and St. Jude/Abbott stylet-driven leads in a mixed cohort of patients at hospitals lacking an EP recording system. Conduction system capture was assessed using modified V1 and V6 leads.

Results

LBBaP was successful in 18 (94.7%) of 19 patients. There was excellent correlation between 12-lead ECG and modified V1 and V6 leads connected to the PSA regarding the measurement of V6 left ventricular activation time and QRS morphology change in V1 during selective to nonselective left bundle branch capture. Patient characteristics were the following: mean age of 66.7 ± 11.47 years, 52.63% male, 10.52% with ischemic cardiomyopathy, and 5.26% with nonischemic cardiomyopathy. LBBaP resulted in a QRS duration of 112.77 ±11.27 ms with a left ventricular activation time of 70.55 ± 8.02 ms. Left ventricular ejection fraction improved in the patients with cardiomyopathy from 33.4 ± 5.77% to 48.2 ± 12.37% (P = .028).

Conclusion

The modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful LLBaP.

查看原文本刊更多论文

背景在资源匮乏的环境中，由于医疗成本的限制，配备功能齐全的电生理学（EP）手术室和电生理学记录系统存在很大障碍。该研究旨在评估在左束支区起搏（LBBaP）过程中，使用传统的跑步机测试机 12 导联心电图系统和连接到起搏系统分析仪（PSA）的改良 V1 和 V6 导联来展示传导系统捕获的可行性和结果。方法在缺乏 EP 记录系统的医院中，由一名操作员使用美敦力 3830 无腔导联和 St.结果 19 例患者中有 18 例（94.7%）成功进行了 LBBaP。在选择性左束支捕获到非选择性左束支捕获期间，12 导联心电图与连接到 PSA 的改良 V1 和 V6 导联之间在测量 V6 左室激活时间和 V1 QRS 形态变化方面具有极佳的相关性。患者特征如下：平均年龄（66.7 ± 11.47）岁，52.63%为男性，10.52%患有缺血性心肌病，5.26%患有非缺血性心肌病。LBBaP导致QRS持续时间为（112.77 ± 11.27）毫秒，左心室激活时间为（70.55 ± 8.02）毫秒。心肌病患者的左室射血分数从 33.4 ± 5.77% 提高到 48.2 ± 12.37% (P = .028)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊