Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Ignacy Jastrzębski, Patryk Stanisław Michel, Marek Rajzer, Marek Jastrzębski
{"title":"用于诊断左束支截获的全局 R 波峰值时间。","authors":"Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Ignacy Jastrzębski, Patryk Stanisław Michel, Marek Rajzer, Marek Jastrzębski","doi":"10.1016/j.hrthm.2024.10.038","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>QRS axis deviation and rS configuration in V6 affect the ability of V6 R-wave peak time (RWPT) criterion to discriminate capture type during left bundle branch area pacing (LBBAP).</p><p><strong>Objective: </strong>We hypothesized that combining RWPTs from lateral leads: I, aVL, V5, and V6 may better reflect left ventricular activation time and that such a global RWPT may be insensitive to changes in QRS configuration.</p><p><strong>Methods: </strong>The analysis included 519 electrocardiograms (ECGs) with nonselective left bundle branch pacing (nsLBBP) and 176 ECGs with left ventricular septal pacing (LVSP). Optimal RWPT cutoffs and area under the receiver operating curve (AUC) were determined for each lead and combinations of leads, to find the best RWPT criterion for discriminating nsLBBP from LVSP. Values were reported separately for healthy and diseased left conduction system groups.</p><p><strong>Results: </strong>The highest AUC of 97.1/89.2% was obtained for the global RWPT, which combined leads I and V6. The AUC for single-lead RWPT, was highest for lead I, followed by V6, V5, and aVL with AUC of 95.1/87.4%, 93.6/87.1%, 93.0/86.5%, and 84.8/74.6%, respectively. The global RWPT criterion was not affected by variations in QRS configuration, as V6 and I RWPTs often showed opposite responses to changes in axis. In contrast, all single-lead RWPT criteria were sensitive to axis deviation and QRS configuration. Diagnostically optimal RWPT cutoffs for global RWPT and lead I RWPT were 162.5/187.5 ms, and 81.5/90.5 ms, respectively.</p><p><strong>Conclusion: </strong>The global RWPT criterion allows a more accurate diagnosis of LBBAP capture type independent of QRS configuration and axis.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Global R-wave peak time for diagnosis of left bundle branch capture.\",\"authors\":\"Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Ignacy Jastrzębski, Patryk Stanisław Michel, Marek Rajzer, Marek Jastrzębski\",\"doi\":\"10.1016/j.hrthm.2024.10.038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>QRS axis deviation and rS configuration in V6 affect the ability of V6 R-wave peak time (RWPT) criterion to discriminate capture type during left bundle branch area pacing (LBBAP).</p><p><strong>Objective: </strong>We hypothesized that combining RWPTs from lateral leads: I, aVL, V5, and V6 may better reflect left ventricular activation time and that such a global RWPT may be insensitive to changes in QRS configuration.</p><p><strong>Methods: </strong>The analysis included 519 electrocardiograms (ECGs) with nonselective left bundle branch pacing (nsLBBP) and 176 ECGs with left ventricular septal pacing (LVSP). Optimal RWPT cutoffs and area under the receiver operating curve (AUC) were determined for each lead and combinations of leads, to find the best RWPT criterion for discriminating nsLBBP from LVSP. Values were reported separately for healthy and diseased left conduction system groups.</p><p><strong>Results: </strong>The highest AUC of 97.1/89.2% was obtained for the global RWPT, which combined leads I and V6. The AUC for single-lead RWPT, was highest for lead I, followed by V6, V5, and aVL with AUC of 95.1/87.4%, 93.6/87.1%, 93.0/86.5%, and 84.8/74.6%, respectively. The global RWPT criterion was not affected by variations in QRS configuration, as V6 and I RWPTs often showed opposite responses to changes in axis. In contrast, all single-lead RWPT criteria were sensitive to axis deviation and QRS configuration. Diagnostically optimal RWPT cutoffs for global RWPT and lead I RWPT were 162.5/187.5 ms, and 81.5/90.5 ms, respectively.</p><p><strong>Conclusion: </strong>The global RWPT criterion allows a more accurate diagnosis of LBBAP capture type independent of QRS configuration and axis.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"88\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2024.10.038\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"88","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.10.038","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Global R-wave peak time for diagnosis of left bundle branch capture.
Background: QRS axis deviation and rS configuration in V6 affect the ability of V6 R-wave peak time (RWPT) criterion to discriminate capture type during left bundle branch area pacing (LBBAP).
Objective: We hypothesized that combining RWPTs from lateral leads: I, aVL, V5, and V6 may better reflect left ventricular activation time and that such a global RWPT may be insensitive to changes in QRS configuration.
Methods: The analysis included 519 electrocardiograms (ECGs) with nonselective left bundle branch pacing (nsLBBP) and 176 ECGs with left ventricular septal pacing (LVSP). Optimal RWPT cutoffs and area under the receiver operating curve (AUC) were determined for each lead and combinations of leads, to find the best RWPT criterion for discriminating nsLBBP from LVSP. Values were reported separately for healthy and diseased left conduction system groups.
Results: The highest AUC of 97.1/89.2% was obtained for the global RWPT, which combined leads I and V6. The AUC for single-lead RWPT, was highest for lead I, followed by V6, V5, and aVL with AUC of 95.1/87.4%, 93.6/87.1%, 93.0/86.5%, and 84.8/74.6%, respectively. The global RWPT criterion was not affected by variations in QRS configuration, as V6 and I RWPTs often showed opposite responses to changes in axis. In contrast, all single-lead RWPT criteria were sensitive to axis deviation and QRS configuration. Diagnostically optimal RWPT cutoffs for global RWPT and lead I RWPT were 162.5/187.5 ms, and 81.5/90.5 ms, respectively.
Conclusion: The global RWPT criterion allows a more accurate diagnosis of LBBAP capture type independent of QRS configuration and axis.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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