Pacing system analyzers to guide conduction system pacing implantation procedures

Background: Left bundle branch area pacing (LBBAP) needs confirmation of left conduction system capture assessed by testing of different electrical parameters. Guidelines recommend the use of an electrophysiology recording system (EP-RS) to guide conduction system pacing procedures. However, some ex...

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Bibliographic Details
Authors: Jiménez-López, Jesús|||0000-0002-4461-996X, González Matos, Carlos Eduardo|||0000-0002-6708-9279, Rodríguez-Queraltó, Oriol|||0000-0003-2746-3243, Francisco Pascual, Jaume|||0000-0002-8841-2581, Lal-Trehan Estrada, Nisha, Martín-Sánchez, Gabriel|||0000-0002-9561-6400, Cabrera-Gómez, Sandra, Molina Lerma, Manuel|||0000-0002-3988-6721, Casteigt, Benjamín, Mercè-Klein, Jordi, Rodríguez-García, Marcos A., Benito-Martín, Eva, Conejos-Montenegro, Javier, Rodríguez Garrido, Jorge Luis, Elices Teja, Juliana, Cosialls Guillen, Pau, Toledo Silva, Aitor, Reitmaier, Carolina, Vallès Gras, Ermengol
Format: article
Publication Date:2025
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:311313
Online Access:https://ddd.uab.cat/record/311313
https://dx.doi.org/urn:doi:10.1016/j.hrthm.2024.12.030
Access Level:Open access
Keyword:Conduction system pacing
Left bundle branch area pacing
Electrophysiological recording system
Pacing system analyzer
Surface Electrocardiogram leads
Description
Summary:Background: Left bundle branch area pacing (LBBAP) needs confirmation of left conduction system capture assessed by testing of different electrical parameters. Guidelines recommend the use of an electrophysiology recording system (EP-RS) to guide conduction system pacing procedures. However, some experienced centers perform LBBAP procedures without an EP-RS. Objective: We aimed to assess whether LBBAP criteria can be measured by the signals provided by the pacing system analyzers (PSAs) as a surrogate for the EP-RS to simplify and universalize the technique. Methods: This was an observational, prospective, multicenter study assessing the current LBBAP criteria using the PSA compared with the EP-RS during conduction system pacing procedures. Results: A consecutive 108 patients were included. Baseline QRS duration was 130 ± 29 ms in the EP-RS vs 128 ± 29 ms in the PSA (P =.7). An initial W morphology in V was noted in 88% of patients with the EP-RS vs 86% of patients with the PSA (P =.7) during unipolar pacing. The QRS duration (122 ± 17 ms vs 123 ± 19 ms; P =.7), the R-wave peak time interval in V (80 ± 13 ms vs 79 ± 14 ms (P =.9), and the V-V interpeak interval (39 ± 16 ms vs 38 ± 17 ms (P =.7) were superimposable in the EP-RS compared with the PSA. Pearson coefficients for the last 2 criteria were 0.85 (P <.0001) and 0.94 (P <.0001), respectively. According to the current criteria, 91.5% of patients received a successful LBBAP implant using the EP-RS. Based on the PSA measurements, 96.6% of these patients met LBBAP criteria. Conclusion: Criteria for LBBAP can be assessed by PSAs with high accuracy. These results provide the basis for the usefulness of the PSA to guide LBBAP procedures.

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