Key result
A novel 2-step ECG algorithm based on QRS notch/slur and R-wave peak time correctly classified 87.1% of cases of loss of His bundle capture, with 93.2% sensitivity and 83.9% specificity.
Why the study?
Permanent His bundle pacing is usually accompanied by non-selective capture of adjacent right ventricular myocardium, and electrocardiographic criteria for loss of His bundle capture were needed.
Does a novel 2-step ECG algorithm accurately diagnose loss of His bundle capture during presumed non-selective His bundle pacing?
Observational (n=226)
Blinded observers
Does a novel 2-step ECG algorithm accurately diagnose loss of His bundle capture during presumed non-selective His bundle pacing?
Effect estimate: Sensitivity 93.2%, Specificity 83.9%
A novel 2-step ECG algorithm based on QRS notch/slur and R-wave peak time in V6 provides high sensitivity and specificity for diagnosing loss of His bundle capture.
May aid ECG diagnosis of His bundle capture loss; hypothesis-generating and requires prospective validation before practice change.
Aims Permanent His bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. Methods Consecutive patients with permanent HB pacing were recruited. Surface 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss/presence of HB capture were identified. In the validation phase these criteria and the “HB ECG algorithm” were tested by two blinded observers using a separate, sizable set of ECGs. Results A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. Moreover, the proposed criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in leads I, V1, V4-V6 and the R-wave peak time in V6 ≤ 100 ms) presented 100% specificity. Conclusion A novel ECG algorithm for the diagnosis of loss of HB capture and novel criteria for definitive confirmation of HB capture were formulated and validated. Practical application of these criteria during implant and follow-up of patients with HB pacing devices is feasible. Condensed Abstract The 2-step ECG algorithm for loss of His bundle capture based on surface ECG analysis is proposed and validated. This method correctly classified 87.1% of cases with a sensitivity and specificity of 93.2% and 83.9%, respectively. What’s New This is the first study that analyzes QRS characteristics during non-selective His bundle pacing in a sizable cohort of patients. Precise criteria and a novel algorithm for electrocardiographic diagnosis of loss of HB capture during presumed non-selective HB pacing were validated. QRS notch/slur in left ventricular leads was identified as a simple and reproducible feature indicating loss of HB capture or lack/loss of correction of intraventricular conduction disturbances. Assessment of R-wave peak time in lead V6 rather than QRS duration for diagnosis of ns-HB pacing was validated.
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Jastrzębski et al. (2019) conducted an observational in Permanent His bundle pacing (n=226). 2-step HB ECG algorithm was evaluated on Correct classification of loss of His bundle capture (Sensitivity 93.2%, Specificity 83.9%). A novel 2-step ECG algorithm based on QRS notch/slur and R-wave peak time correctly classified 87.1% of cases of loss of His bundle capture, with 93.2% sensitivity and 83.9% specificity.
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