Key result
Flecainide masks standard LBB capture criteria, requiring alternative thresholds like V6RWPT <90 ms or drug discontinuation.
Why the study?
Does flecainide therapy affect the assessment of left bundle branch capture criteria during pacemaker implantation?
Does flecainide therapy affect the assessment of left bundle branch capture criteria during pacemaker implantation?
Flecainide therapy can mask standard left bundle branch capture criteria, necessitating alternative diagnostic criteria or temporary drug discontinuation prior to pacemaker implantation.
May warrant alternative V6RWPT thresholds or temporary flecainide pause during LBB capture assessment; leaves open prospective validation of revised criteria.
Key Teaching Points•Flecainide is a class Ic antiarrhythmic that can increase the QRS duration and left ventricular activation times.•Electrophysiologists need to be aware of potential masking of standard left bundle branch (LBB) capture criteria (stim to R-wave peak time in V6 [V6RWPT] <80 ms) when patients are on flecainide therapy.•Either direct evidence of LBB capture (diagnostic morphology changes during threshold testing or programmed electrical stimulation) or comprehensive analysis of other LBB criteria (eg, V6RWPT <90 ms in the setting of intrinsic conduction delay, V6-V1 interpeak interval ≥33 ms, LBB pacing score) should be sought to fully assess for LBB capture in patients taking flecainide.•Temporary flecainide discontinuation should be considered prior to LBB pacemaker implantation to improve diagnostic performance of conventional LBB capture criteria. •Flecainide is a class Ic antiarrhythmic that can increase the QRS duration and left ventricular activation times.•Electrophysiologists need to be aware of potential masking of standard left bundle branch (LBB) capture criteria (stim to R-wave peak time in V6 [V6RWPT] <80 ms) when patients are on flecainide therapy.•Either direct evidence of LBB capture (diagnostic morphology changes during threshold testing or programmed electrical stimulation) or comprehensive analysis of other LBB criteria (eg, V6RWPT <90 ms in the setting of intrinsic conduction delay, V6-V1 interpeak interval ≥33 ms, LBB pacing score) should be sought to fully assess for LBB capture in patients taking flecainide.•Temporary flecainide discontinuation should be considered prior to LBB pacemaker implantation to improve diagnostic performance of conventional LBB capture criteria.
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Shadrin et al. (2023) conducted a review in Patients on flecainide therapy undergoing left bundle branch pacemaker implantation. Flecainide was evaluated on Left bundle branch (LBB) capture criteria. Flecainide therapy can mask standard left bundle branch capture criteria (V6RWPT <80 ms), requiring alternative criteria like V6RWPT <90 ms or temporary drug discontinuation prior to implantation.
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