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Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

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Abstract

Background

Left bundle branch pacing (LBBP) is a novel near-physiological pacing method that still lacks quantitative criteria to guide the selection of lead-implanted sites to enhance the success likelihood of lead deployments. This study aimed to quantitatively analyze the relationships of LBBP success likelihood to the distribution of lead-implanted sites and the lead-localization-pacing electrocardiographic (ECG) features.

Methods

All the lead-implanted sites in patients with finally successful LBBP were enrolled for analysis, including successful and failed sites. A novel coordinate system was invented to describe the sites’ distribution as longitudinal distance (longit-dist) and lateral distance (lat-dist). Corrected distance parameters were generated to eliminate the cardiac dimension variations. The lead-localization-pacing ECG parameters were also collected, such as paced QRS duration (locat-QRSd), left ventricular activation time (locat-LVAT), LVAT/QRSd ratio (locat-LVAT/QRSd), and QRS directions.

Results

A total of 94 patients with 105 successful sites and 93 failed sites were enrolled. Longit-dist and corrected longit-dist of successful sites were significantly longer, while locat-QRSd and locat-LVAT were shorter and locat-LVAT/QRSd was lower than failed sites. There was a positive dose–response relationship between LBBP success likelihood and corrected longit-dist with a cut-off of 26.95 mm, whereas there were negative dose–response relationships of LBBP success likelihood to locat-QRSd, locat-LVAT, and locat-LVAT/QRSd with the cut-offs of 142 ms, 92 ms, and 64.7%, respectively. Downward QRS direction in II/III ECG leads was also associated with successful LBBP.

Conclusion

Longit-dist, locat-QRSd, locat-LVAT, and locat-LVAT/QRSd were quantitative parameters to guide the selection of lead-implanted sites during LBBP implantation.

Graphical abstract

Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing. LBBP, left bundle branch pacing; Longit-dist, longitudinal distance; CL-apex-dist, distance from contraction line to apex; LBBB, left bundle branch block; IVCD, intraventricular conduction delay; Locat-QRSd, lead-localization-pacing QRS duration; Locat-LVAT, lead-localization-pacing left ventricular activation time; Locat-LVAT/QRSd, lead-localization-pacing LVAT/QRSd ratio.

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Data availability

The data underlying this article cannot be shared publicly due to the data confidentiality policy of the National Center for Cardiovascular Diseases (China).

Code availability

The codes used are available from the corresponding author upon reasonable request.

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Funding

Supported by the National Natural Science Foundation of China (Grant Number 81870260) and the Central Public-Interest Scientific Institution Basal Research Fund: Chinese Academy of Medical Sciences (Internal Grant Number 2018-F01).

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Authors and Affiliations

  1. State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China

    Wenzhao Lu, Jinxuan Lin, Keping Chen, Yan Dai, Ruohan Chen, Qingyun Hu, Yao Li, Chendi Cheng, Yu’an Zhou & Shu Zhang

Authors
  1. Wenzhao Lu
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  2. Jinxuan Lin
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  3. Keping Chen
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  4. Yan Dai
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  5. Ruohan Chen
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  6. Qingyun Hu
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  7. Yao Li
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  8. Chendi Cheng
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  9. Yu’an Zhou
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  10. Shu Zhang
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Contributions

WL, JL, KC and YD came up with the conception and designed the study. Data collection was completed by WL. Data analysis, result interpretation and article drafting were performed by WL. All the authors participated in the LBBP operation, clinical practice and article revisions. The final approval of the submitted version was performed by KC, YD, and SZ.

Corresponding authors

Correspondence to Keping Chen or Yan Dai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This work was approved by the Ethics Committee of Fuwai Hospital (Approval No. 2019-1149) and obeyed the Declaration of Helsinki.

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Lu, W., Lin, J., Chen, K. et al. Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing. Clin Res Cardiol 111, 1219–1230 (2022). https://doi.org/10.1007/s00392-021-01965-1

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  • DOI: https://doi.org/10.1007/s00392-021-01965-1

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