Key result
Anodal-ring capture during LBBP succeeds in 62% of patients and shortens stimulus-to-QRS duration.
Why the study?
Although anodal-ring capture during bipolar LBBP improves right ventricular conduction delay, it is not achieved in all patients receiving LBBP.
What factors influence the successful implementation of anodal-ring capture during left bundle branch pacing?
Observational (n=105)
What factors influence the successful implementation of anodal-ring capture during left bundle branch pacing?
Successful anodal-ring capture during left bundle branch pacing, which improves right ventricular conduction delay, is facilitated by better ring-septum contact and specific lead-tip positioning.
Anodal-ring capture may shorten QRS duration during left bundle branch pacing; Level 3 data leaves open need for randomized outcome trials.
AIMS: Left bundle branch pacing (LBBP) maintains left ventricular synchrony but induces right ventricular conduction delay (RVCD). Although anodal-ring capture (ARC) during bipolar LBBP improves RVCD, it is not achieved in all patients receiving LBBP. This study aimed to analyze the factors influencing ARC implementation. METHODS AND RESULTS: Patients receiving LBBP with intraoperative ARC testing were enrolled. Electrocardiographic parameters were measured, including stimulus-to-QRS duration (stim-QRSd), stimulus-to-left/right ventricular activation time (stim-LVAT/RVAT), and V6-V1 interpeak interval. The distribution of lead-tip sites was described as the corrected longitudinal and lateral distance (longit-/lat-dist). Relative angles of the LBBP lead were measured. Echocardiography in short-axis view was used to measure the intraseptal lead length. Intergroup comparisons, correlation analysis, and stepwise logistic regression were performed. In total, 105 patients were included, among which 65 (62%) patients achieved ARC at a pacing output ≤ 5.0 V/0.5 ms (average 3.1 V/0.5 ms). Anodal-ring capture further shortened the stim-QRSd by 13.1 ± 7.5 ms. Better unipolar-ring (cathodal) threshold and R-wave sensing in LBBP-ARC group indicated the critical role of ring-septum contact in ARC. Longer corrected longit-dist and shorter corrected lat-dist of lead-tip sites were positively correlated with higher success likelihood of ARC, likely due to the greater relative angle in which the lead enters the septum and consequently the longer intraseptal lead length and better ring-septum contact. CONCLUSION: This study elucidated the factors affecting the success likelihood of LBBP-ARC. These findings improve the understanding of LBBP-ARC, providing references for future research and clinical practice.
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Lu et al. (2023) conducted an observational in Left bundle branch pacing (n=105). Anodal-ring capture (ARC) during bipolar LBBP was evaluated on Achievement of anodal-ring capture (ARC) at a pacing output ≤ 5.0 V/0.5 ms. Anodal-ring capture during left bundle branch pacing was achieved in 62% of patients and further shortened the stimulus-to-QRS duration by 13.1 ± 7.5 ms.
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