Both His-bundle pacing and peri-left bundle pacing synchronized left ventricular electrical activation in a patient with LBBB, reducing LV total activation time from 110 ms to 36 ms and 42 ms.
Case Report (n=1)
Do His-bundle pacing and peri-left bundle pacing synchronize electrical activation in a patient with left bundle branch block?
Non-invasive ECGi mapping demonstrates that both His-bundle and peri-left bundle pacing can effectively resynchronize the left ventricle in LBBB, with PLBP potentially offering more favorable pacing parameters.
We reported a case of using non-invasive global epicardial electrogram electrocardiographic imaging (ECGi) mapping to demonstrate both His-bundle pacing (HBP) and peri-left bundle pacing (PLBP) were able to synchronize the electrical activation pattern of a lady with left bundle branch block (LBBB). Selective HBP (SHBP) with threshold of 1.8 V at 0.5 ms and sensing of 3.2 mV achieved correction of the LBBB and shortening of QRS width from baseline. Non-selective HBP (NSHBP) was observed at higher pacing output. Peri-left bundle pacing resulted in narrowing of QRS width and emergence of qR pattern in lead V1 indicating capturing of the left bundle. The pacing threshold was 0.8 mV at 1.0 ms and sensing was 4.5 mV. Electrocardiographic imaging recording of the intrinsic rhythm showed a line of conduction block in the left ventricle (LV) with the latest activation in posterolateral LV. In contrary, both SHBP and PLBP demonstrated synchronous activation of the LV. The LV total activation time for intrinsic rhythm, SHPB, and PLBP were 110 ms, 36 ms, and 42 ms, respectively. The total global activation time for intrinsic rhythm, SHPB, and PLBP were 117 ms, 38 ms, and 48 ms, respectively. In this case report the advantages of PLBP over SHBP, by pacing more distally and further away from the membranous septum, were lower pacing threshold and increased R-wave sensing. The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
Chan et al. (2018) conducted a case report in left bundle branch block (LBBB) (n=1). His-bundle pacing and peri-left bundle pacing vs. intrinsic rhythm was evaluated on Left ventricular total activation time. Both His-bundle pacing and peri-left bundle pacing synchronized left ventricular electrical activation in a patient with LBBB, reducing LV total activation time from 110 ms to 36 ms and 42 ms.