Key result
T-wave inversions occurred in 66.3% of patients during left bundle branch area pacing, were mostly recoverable, and were independently predicted by a baseline QRS duration >120 ms.
Why the study?
T-wave inversions appeared during left bundle branch area pacing, but their incidence and influencing factors were unclear.
What is the incidence and what are the predictive factors of T-wave inversions during left bundle branch area pacing?
Cohort (n=398)
No
What is the incidence and what are the predictive factors of T-wave inversions during left bundle branch area pacing?
T-wave inversions are a frequent but recoverable electrocardiographic finding during left bundle branch area pacing, independently predicted by a baseline QRS duration >120 ms.
T-wave inversions after LBBAP are often transient; supports monitoring in wide-QRS patients but leaves clinical impact open.
BACKGROUND: Our clinical observation found that T-wave inversions (TWIs) appeared during left bundle branch area pacing (LBBAP); however, the incidence and influencing factors were unclear. The study aimed to investigate the effects of LBBAP on T-wave and explore possible factors associated with TWIs. METHODS: This was a retrospective cohort study. An electrocardiogram (ECG) was acquired at baseline and after LBBAP. Baseline characteristics, ECG parameters, LBBAP parameters, and troponin T (TnT) levels were compared between the non-TWIs and TWIs groups. Multivariable logistic analyses were performed to adjust for potential confounders to identify the predictive factors of TWIs during LBBAP. RESULTS: A total of 398 consecutive patients who underwent successful LBBAP were assessed for inclusion between May 2017 and Jan 2021, and 264 (66.3%) patients had TWIs. The mean (standard deviation [SD]) baseline QRS duration (QRSd) was longer in the TWIs group compared to the non-TWIs group (125.9 [34.5] ms vs. 98.2 [18.1] ms; P <0.001). Multivariable logistic regression analysis suggested that QRSd >120 ms was an independent predictor for TWIs. TWIs were partially or com-pletely recovered in 151/172 (87.8%) patients during follow-up, the median (interquartile range [IQR]) follow-up duration was 10 days (7 days to 5.5 months). TWIs in patients with complete left bundle branch block (CLBBB) occurred more frequently in inferior wall leads (II, III, and aVF) and anterior wall leads (V1-V4) (P <0.05). Patients with complete right bundle branch block (CRBBB) were more prone to TWIs in high lateral wall leads (I and aVL) (P <0.05). There were no significant differences in TnT levels between the TWIs and non-TWIs groups. CONCLUSIONS: TWIs during LBBAP were clinically frequent and recoverable. QRSd >120 ms was independently associated with TWIs.
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Geng et al. (2022) conducted a cohort in Pacemaker indication (n=398). Left bundle branch area pacing (LBBAP) was evaluated on Incidence of T-wave inversions (TWIs). T-wave inversions occurred in 66.3% of patients during left bundle branch area pacing, were mostly recoverable, and were independently predicted by a baseline QRS duration >120 ms.
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