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Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch (LBB) pacing (LBBP), as a physiological pacing strategy, can achieve interventricular and/or intra-left ventricular mechanical synchronization by delivering physiological or nearly physiological ventricular activation. And many studies have verifed clinical efficacy of CSP that it can significantly relieve dyssynchrony of ventricular contraction, improve cardiac function and reduce the risk of heart failure as compared to right ventricular pacing. However, CSP has some shortcomings which limit its widespread application to some extent. As for HBP, although it can achieve optimal physiological ventricular synchronization, the problems of relatively high pacing threshold, low R-wave amplitude, the long-term performance, and inability to correct infra-Hisian atrioventricular block and intraventricular block in some patients have always been concerns. Nevertheless, LBBP is likely free of the restrictions mentioned above. On the contrary, LBBP can capture the left conduction system by directly stimulating the proximal LBB distal to the site of conduction block, thereby achieving rapid and physiological LV activation with a lower and stable pacing threshold and higher R-wave amplitude. However, as a newly emerged physiologic pacing technology, LBBP is currently in the exploratory stage and there are some phenomena to be interpreted, such as the evolution of pacing QRS morphology during the lead penetration into the interventricular septum. Therefore, the aim of this study is to assess the morphological evolution and electrophysiological characteristics of various pacing QRS patterns observed as the lead penetrates the interventricular septum from right to left.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| All patients | Patients who meet the inclusion criteria |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| left bundle branch pacing | Procedure | In the procedure of left bundle branch pacing, various QRS morphologies are observed as penetrating the lead into the interventricular septum. |
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular activation time (LVAT) | Left ventricular activation time (LVAT) is defined as the interval from the onset of the pacing stimulus to the peak of the R wave in lead V5/6, which reflects the lateral precordial myocardium depolarization time. | Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |
| Right ventricular activation time (RVAT) | Right ventricular activation time (RVAT) is defined as the interval from the onset of the pacing stimulus to the peak potential recorded by the atrial electrode temporarily placed in the right ventricle, which reflects delayed right ventricular activation. | Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |
| Paced QRS morphology | Paced QRS morphology during lead penetration through the interventricular septum mainly includes left bundle branch block, intraventricular block and right bundle branch block. | Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |
| Measure | Description | Time Frame |
|---|---|---|
| Stimulus-QRSend duration (s-QRSend) | Stimulus-QRSend duration (s-QRSend) is the time from the onset of the pacing stimulus to the end of QRS complex. | Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |
| The late-R wave duration and amplitude in lead V1 (r´dur、r´amp) |
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Inclusion Criteria:
Exclusion Criteria:
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Patients requiring a high percentage of ventricular pacing (>40% expected ventricular pacing) include patients with advanced or third-degree atrioventricular block and atrial fibrillation with bradycardia.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yanchun Liang, MD、PhD | Contact | +86-13309886380 | liangyanchun@sina.com |
| Name | Affiliation | Role |
|---|---|---|
| Yanchun Liang, MD、PhD | The General Hospital of Northern Theater Command | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| General Hospital of Northern Theater Command | Recruiting | Shenyang | Liaoning | 110016 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34662435 | Background | Shimeno K, Tamura S, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Characteristics and proposed mechanisms of QRS morphology observed during the left bundle branch pacing procedure. Pacing Clin Electrophysiol. 2021 Dec;44(12):1987-1994. doi: 10.1111/pace.14382. Epub 2021 Oct 31. | |
| 33390564 | Background | Zhang J, Sheng X, Pan Y, Wang M, Fu G. Electrophysiological Insights into Three Modalities of Left Bundle Branch Area Pacing in Patients Indicated for Pacing Therapy. Int Heart J. 2021 Jan 30;62(1):78-86. doi: 10.1536/ihj.20-490. Epub 2020 Dec 26. |
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The late-R wave duration in lead V1 indicates delayed right ventricular excitation. |
| Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |
| The S wave duration and amplitude in lead V6 (Sdur、Samp) | The S wave duration in lead V6 indicates delayed right ventricular excitation. | Continuous uninterrupted monitoring during the lead penetration into the interventricular septum. |