In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
Abstract:
Introduction: Left bundle branch area pacing (LBp) is a newer technique to deliver more synchronous left ventricular activation. Several criteria have been proposed, but not fully validated, to confirm LBp during implantation of pacing lead. Hypothesis: We hypothesized that higher frequency content of the paced QRS complex may show predictive value of successful LBp. Methods: We evaluated 84 patients with ejection fraction 〉 50%, who underwent LBB lead placement (n=42) using ≥1 current criteria and right ventricular midseptal (RVsp) lead placement (n=42) from 2000-22. Time frequency analysis (Matlab) was used to determine frequency content of paced QRS complex. Centroid Frequency (CF), which is the weighted average QRS frequency, was calculated. Unpaired t-test and Chi Square test were used for continuous and categorical variables, respectively. Multivariate analysis using logistic regression was used for variables with univariate p 〈 0.20. Variables with significant multivariate comparison (p 〈 0.05) underwent receiver operator curve analysis. Sensitivity and specificity for a CF ≥7.0 Hz for LBp was determined. Results: Baseline clinical characteristics are listed in Table 1. Patients in RVsp group had longer paced QRS duration (155.6 ± 28.0 vs 127.1 ± 17.2, p 〈 0.002) compared to LBp group. Of all ECG leads, V2 gave greatest difference, with CF of LBp group at 8.8 ± 1.6 Hz vs 5.7 ± 0.7 Hz of RVsp group (fig 1). This difference was significant by both univariate (p 〈 0.003) and multivariate (p 〈 0.010) analysis. Predictive value of CF for successful LBB pacing in lead V2 was highest with an AUC of 0.98. Sensitivity and specificity were 88.1% and 97.6%, respectively. Conclusions: Spectral analysis predicts successful LBp with higher frequency content when compared to RVsp pacing. Given the limitations to the current criteria to confirm LBp, intraprocedural use of frequency content analysis of the paced QRS complex in patients may prove a useful means of identifying LBB capture
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.146.suppl_1.13335
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
1466401-X
