scholarly journals Programmed deep septal pacing for the diagnosis of left bundle branch capture

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Aleksander Kusiak ◽  
Agnieszka Bednarek ◽  
Tomasz Sondej ◽  
...  
Keyword(s):  
Refractory Period ◽  
Pacemaker Implantation ◽  
Drive Train ◽  
Effective Refractory Period ◽  
Qrs Complex ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Qrs Morphology ◽  
Premature Beats ◽  
Septal Myocardium

AbstractBackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB) capture.ObjectiveThe effective refractory period (ERP) of the working myocardium is different than the ERP of the LBB; we hypothesized that it should be possible to differentiate LBB capture from septal myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients undergoing pacemaker implantation who received pacing lead in a deep septal position programmed pacing was delivered from this lead. Responses to programmed pacing were categorized on the basis of QRS morphology of the extrastimuli as: myocardial (broader QRS, often slurred), selective (narrower QRS, preceded by an isoelectric interval) or non-diagnostic (unequivocal change).ResultsProgrammed deep septal pacing was performed 269 times in 143 patients; in every patient with the use of an 8-beat basic drive train of 600 ms and when possible also during supraventricular rhythm. Responses diagnostic for LBB capture were observed in 114 (79.7%) of patients. Selective LBB paced QRS was more often seen when premature beats were introduced during the intrinsic rhythm rather than after the basic drive train. The average septal-myocardial refractory period was significantly shorter than the LBB refractory period: 263.0±34.4 ms vs. 318.0±37.4 ms.ConclusionsA novel maneuver for the diagnosis of LBB capture during deep septal pacing, was formulated, assessed and found as diagnostically valuable. This method, based on the differences in refractoriness between LBB and the septal myocardium is unique in enabling the visualization of components of the usually fused, non-selective LBB paced QRS complex.Graphical abstract

scholarly journals Programmed His bundle pacing - a novel maneuver for the diagnosis of His bundle capture

2018 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Agnieszka Bednarek ◽  
Grzegorz Kiełbasa ◽  
Pugazhendhi Vijayaraman ◽  
...  
Keyword(s):  
Abrupt Change ◽  
Pacemaker Implantation ◽  
Drive Train ◽  
List Type ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Coupling Interval ◽  
Septal Pacing ◽  
Qrs Morphology ◽  
Premature Beats

AbstractBackgroundDuring permanent non-selective (ns) His bundle (HB) pacing, it is crucial to confirm HB capture / exclude that only right ventricle (RV)-myocardial septal pacing is present. Because the effective refractory period (ERP) of the working myocardium is different than the ERP of the HB, we hypothesized that it should be possible to differentiate ns-HB capture from RV-myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients during HB pacemaker implantation, programmed HB pacing was delivered from the screwed-in HB pacing lead. Premature beats were introduced at 10 ms steps during intrinsic rhythm and also after a drive train of 600 ms. The longest coupling interval that resulted in an abrupt change of QRS morphology was considered equal to ERP of HB or RV-myocardium.ResultsProgrammed HB pacing was performed from 50 different sites in 32 patients. In 34/36 cases of ns-HB pacing, the RV-myocardial ERP was shorter than HB ERP (271.8±38 ms vs 353.0±30 ms, p < 0.0001). Programmed HB pacing using a drive train resulted in a typical abrupt change of paced QRS morphology: from ns-HB to RV-myocardial QRS (34/36 cases) or to selective HB QRS (2/36 cases). Programmed HB pacing delivered during supraventricular rhythm resulted in obtaining selective HB QRS in 20/34 and RV-myocardial QRS in 14/34 of the ns-HB cases. In RV-myocardial only pacing cases (“false ns-HB pacing”, n=14), such responses were not observed – the QRS morphology remained stable. Therefore, the PHB pacing correctly diagnosed all ns-HB cases and all RV-myocardial pacing cases.ConclusionsA novel maneuver for the diagnosis of HB capture, based on the differences in ERP between HB and myocardium was formulated, assessed and found as diagnostically valuable. This method is unique in enabling to visualize selective HB QRS in patients with otherwise obligatory ns-HB pacing (RV-myocardial capture threshold < HB capture threshold).What this study addsProgrammed His bundle pacing – a novel and straightforward method for unquestionable diagnosis of His bundle capture during non-selective pacing was developed and assessed.A method for visualization of selective HB capture QRS in patients with obligatory non-selective pacing (myocardial capture threshold < His bundle capture threshold) was discovered and physiology behind it explained.

scholarly journals Usefulness of lead delivery catheter system for true right ventricular septal pacing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Miyajima ◽  
T Urushida ◽  
K Ito ◽  
F Kin ◽  
A Okazaki ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Septal Wall ◽  
Catheter Group ◽  
Catheter System ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Pacing Lead ◽  
Guiding Catheter ◽  
Delivery Catheter

Abstract Background Right ventricular (RV) septal pacing is often selected to preserve a more physiologic ventricular activation. But the pacing leads are not always located in true septal wall, rather in hinge or free wall in some cases with the conventional stylet-guided lead implantation. In recent years, new guiding catheter systems has attracted attention as a solution to that problem. Objective The aim of this study is to investigate that true ventricular sepal pacing can be achieved by use of the new guiding catheter system for pacing lead. Methods We enrolled 198 patients who underwent RV septal lead implantation and computed tomography (CT) after pacemaker implantation. 16 cases were used delivery catheter (Delivery), and 182 cases were used stylet for targeting ventricular septum (Conventional). We analyzed the lead locations with CT, and evaluated capture thresholds, R-wave amplitudes, lead impedances and 12-lead electrocardiogram findings one month after implantation. Results All cases of delivery catheter group had true septal lead positions (Delivery; 100% vs Conventional; 44%, p&lt;0.01). Capture thresholds and lead impedances had not significant differences between between two groups (0.65±0.15V vs 0.60±0.15V, p=0.21, 570±95Ω vs 595±107Ω, p=0.39, respectively). R-wave amplitudes were significantly higher in delivery catheter group (13.0±4.8mV vs 10±4.6mV, p&lt;0.01). Paced QRS durations were shorter in delivery catheter group (128±16ms vs 150±21ms, p&lt;0.01). Conclusions The delivery catheter system designated for pacing lead can contribute to select the true ventricular septal sites and to attain the more physiologic ventricular activation. Funding Acknowledgement Type of funding source: None

The effect of procainamide in the effective refractory period related to drive train duration

Resuscitation ◽  
1993 ◽  
Vol 25 (1) ◽  
pp. 92
Author(s):  
Antonis M. Sideris ◽  
Gerasimos S. Filippatos ◽  
Efi I. Galiatsu ◽  
Athanasios I. Kranidis ◽  
Konstantinos Kappos ◽  
...  
Keyword(s):  
Refractory Period ◽  
Drive Train ◽  
Effective Refractory Period ◽  
Train Duration

Effects of acetylcholine, propranolol, and verapamil on sinus node refractoriness of the rabbit

1989 ◽  
Vol 67 (10) ◽  
pp. 1232-1239
Author(s):  
Charles R. Kerr
Keyword(s):  
Refractory Period ◽  
Sinus Node ◽  
Effective Refractory Period ◽  
Crista Terminalis ◽  
Premature Beats ◽  
Control State

At a critical premature interval, atrial premature beats encounter sinus node refractoriness and are blocked on entering and fail to reset the sinus node, resulting in interpolation of the premature beat. The transition from reset to interpolated response has been used to define the effective refractory period of the sinus node (SNERP). In an in vitro preparation of rabbit sinus node, we evaluated the effects of acetylcholine, propranolol, and verapamil on SNERP. Results obtained in the control state were compared with those obtained during superfusion with drugs, all of which prolonged refractoriness: acetylcholine from 233 ± 41 (SD) to 325 ± 88 ms; propranolol from 215 ± 60 to 241 ± 67 ms; and verapamil from 192 ± 69 to 254 ± 79 ms (p < 0.005 with all drugs). The site of block of premature beats was mapped between sinus node and crista terminalis with an intracellular microelectrode. All three drugs resulted in block of premature beats at sites farther from the primary pacemaker site. Thus, acetylcholine, propranolol, and verapamil prolong sinus node refractoriness.Key words: acetylcholine, propranolol, verapamil, sinus node, sinus node refractoriness.

Physiological (His-bundle or Left Septal) Pacing – Lead Stability Study

2021 ◽  
Vol 30 ◽  
pp. S164
Author(s):  
C. Chow ◽  
P. Crane ◽  
H. Lim ◽  
U. Mohamed
Keyword(s):  
Stability Study ◽  
His Bundle ◽  
Septal Pacing ◽  
Pacing Lead

scholarly journals Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 822
Author(s):  
Luuk I.B. Heckman ◽  
Justin G.L.M. Luermans ◽  
Karol Curila ◽  
Antonius M.W. Van Stipdonk ◽  
Sjoerd Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Activation Time ◽  
Ventricular Synchrony ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
The Right ◽  
Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

scholarly journals Different lead locations guided by fluoroscopy and ECG parameters and their effect on patients functional status

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Mohamed MesbahTahaHassanin ◽  
Ahmad ShafieAmmar ◽  
Radwa M. Abdullah ◽  
Mohammad Hassan Khedr
Keyword(s):  
Functional Capacity ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Qrs Complex ◽  
Significant Difference ◽  
Septal Pacing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Right ventricular apical pacing with the resultant left ventricular dyssynchrony often leads to depressed systolic function and heart failure. This study aimed at investigating the relation between various septal locations guided by ECG and fluoroscopy and the intermediate term functional capacity of the patients. Results Fifty patients who received a single lead pacemaker with assumed > 90% pacemaker dependency. Patients were randomized according to RV pacing site RV into group 1 “high septum” (n = 15), group 2 “mid septum” (n = 25), and group 3 “low septum” (n = 10) using QRS vector and duration as well as fluoroscopic parameters. Their clinical status was assessed 6 months after device implementation using 6-min walk test (6MWT). The study showed that paced QRS complex duration itself has no significant difference between the different septal pacing locations (P-value 0.675), although its combination with the paced QRS complex vector can signify the optimal pacing site and 6MWT showed a significant difference among the groups in favor of group 1; group 1 (413.3 ± 148.5), group 2 (359.8 ± 124.6), and group 3 (276.0 ± 98.5) P value 0.04. Conclusion There was a significant difference found between the three septal pacing sites concerning the patient functional capacity with superiority of high septal location. By contrast, different septal sites showed no significant difference of the paced QRS complex duration. To optimize the pacing site in the septum, assessment of the paced QRS vector in leads I and III is of a great benefit especially when combined with paced QRS complex duration assessment.

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