Bipolar anodal septal pacing with direct left bundle branch capture significantly improved ventricular dyssynchrony compared to unipolar nonselective left bundle branch pacing (-9 ms vs -24 ms, p<0.001).
Observational (n=116)
No
Does bipolar anodal septal pacing with direct LBB capture improve ventricular electrical dyssynchrony compared to unipolar nonselective LBBP in patients with bradycardia?
Bipolar anodal septal pacing with direct LBB capture improves ventricular synchrony compared to unipolar nonselective LBBP, though it remains less physiological than His bundle pacing.
Absolute Event Rate: -9% vs -24%
p-value: p=<0.001
Background Left bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. Methods In patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1–V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results aLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean −9 ms; 95% CI (−12;−6) vs. −24 ms (−27;−21), ), p 0.001) and shortened local depolarization durations in V1–V4 (mean differences −7 ms to −5 ms (−11;−1), p 0.05) compared to nsLBBP. aLBBP resulted in e-DYS −9 ms (−12; −6) vs. e-DYS 10 ms (7;14), p 0.001 during HBP. Local depolarization durations in V1–V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (−2;6), p = 0.52). Conclusion Although aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.
Čurila et al. (Wed,) conducted a observational in Bradycardia (n=116). Bipolar anodal septal pacing with direct LBB capture (aLBBP) vs. Unipolar nonselective left bundle branch pacing (nsLBBP) was evaluated on Ventricular dyssynchrony (e-DYS) (p=<0.001). Bipolar anodal septal pacing with direct left bundle branch capture significantly improved ventricular dyssynchrony compared to unipolar nonselective left bundle branch pacing (-9 ms vs -24 ms, p<0.001).