Comparison of methods for delivering cardiac resynchronization therapy: an acute electrical and haemodynamic within-patient comparison of left bundle branch area, His bundle, and biventricular pacing

Figure 1. Change in the 12-lead ECG QRS duration. BVP shows the results for the 12 patients in whom BVP was tested, and the HBP and LBBAP show results for all 19 patients. BVP, biventricular pacing; HBP, His bundle pacing; LBBAP, left bundle branch area pacing.

Figure 2. Change in TVAT. This is measured relative to intrinsic conduction using the ECGi system, with all three pacing modalities. The BVP is based on the 12 patients in whom BVP was tested, and the HBP and LBBAP are based on all 19 patients who had HBP and LBBAP. BVP, biventricular pacing, HBP, His bundle pacing; LBBAP, left bundle branch area pacing; TVAT, total ventricular activation time.

Figure 3. Change in LVAT. This was measured relative to intrinsic conduction using the ECGi system, with all three pacing modalities. The BVP is based on the 12 patients in whom BVP was tested, and the HBP and LBBAP are based on all 19 patients who had HBP and LBBAP. BVP, biventricular pacing, LVAT, left ventricular activation time; HBP, His bundle pacing, LBBAP, left bundle branch area pacing.

Figure 4. An example of an activation map recorded during HBP. This shows initial rapid activation of the right ventricle followed by rapid left ventricular activation which occurs from apex to base (arrows) (see online appendix for video). LAD, left anterior descending artery, LV, left ventricle; RV, right ventricle.

Figure 5. An example of an activation map recorded during LBBAP. Early activation of the septal myocardium is observed, likely as a result of local myocardial capture, this is then followed by left ventricle activates which propagates rapidly from apex to base (arrows), in a pattern that is typical for activation via the left ventricular conduction system. Right ventricle activation occurs more slowly than LV activation with late activation of the basal lateral wall (arrows) (video available in online appendix). LAD, left anterior descending artery, LV, left ventricle; RV, right ventricle.

Figure 6. Acute systolic blood pressure response compared with baseline. The BVP data are based on the 12 patients in whom BVP was tested, and the HBP and LBBAP are based on all 19 patients who had HBP and LBBAP. BVP, biventricular pacing, HBP, His bundle pacing, LBBAP, left bundle branch area pacing.