Left Ventricular Lead Placement Targeted at the Latest Activated Site Guided by Electrophysiological Mapping in Coronary Sinus Branches Improves Response to Cardiac Resynchronization Therapy.
Liang Yanchun,Yu Haibo,Zhou Weiwei,Xu Guoqing,Sun Y I,Liu Rong,Wang Zulu,Han Yaling
Journal of cardiovascular electrophysiology
INTRODUCTION:Electrophysiological mapping (EPM) in coronary sinus (CS) branches is feasible for guiding LV lead placement to the optimal, latest activated site at cardiac resynchronization therapy (CRT) procedures. However, whether this procedure optimizes the response to CRT has not been demonstrated. This study was to evaluate effects of targeting LV lead at the latest activated site guided by EPM during CRT. METHODS:Seventy-six consecutive patients with advanced heart failure who were referred for CRT were divided into mapping (MG) and control groups (CG). In MG, the LV lead, also used as a mapping bipolar electrode, was placed at the latest activated site determined by EPM in CS branches. In CG, conventional CRT procedure was performed. Patients were followed for 6 months after CRT. RESULTS:Baseline characteristics were comparable between the 2 groups. In MG (n = 29), EPM was successfully performed in 85 of 91 CS branches during CRT. A LV lead was successfully placed at the latest activated site guided by EPM in 27 (93.1%) patients. Compared with CG (n = 47), MG had a significantly higher rate (86.2% vs. 63.8%, P = 0.039) of response (>15% reduction in LV end-systolic volume) to CRT, a higher percentage of patients with clinical improvement of ≥2 NYHA functional classes (72.4% vs. 44.7%, P = 0.032), and a shorter QRS duration (P = 0.004). CONCLUSIONS:LV lead placed at the latest activated site guided by EPM resulted in a significantly greater CRT response, and a shorter QRS duration.
Cycle length criteria for His-bundle capture are capable of determining pacing types misclassified by output criteria.
Liang Yanchun,Yu Haibo,Wang Na,Liang Zhihao,Xu Baige,Gao Yang,Cha Yong-Mei,Wang Zulu,Han Yaling
BACKGROUND:His-bundle pacing is currently defined according to the output criteria. However, potential nonselective His-bundle pacing (NSHBP) might be misclassified as right ventricular pacing by the output criteria. OBJECTIVE:The purpose of this study was to use the novel cycle length (CL) criteria by decremental CL pacing to determine the type of pacing and to differentiate NSHBP from right ventricular pacing in particular. METHODS:His-bundle pacing was performed in 212 patients with normal His-Purkinje conduction (group 1) and 39 patients with His-Purkinje conduction disease for correction of the condition (group 2). The CL criteria state that if decreasing the CL to a certain level results in QRS morphology changes, then NSHBP is ascertained. RESULTS:NSHBP was obtained in 170 patients in group 1 and 22 patients in group 2. In group 1, NSHBP was validated in 160 patients by both output criteria and CL criteria. NSHBP was misclassified as right ventricular pacing by the output criteria but was correctly classified by CL criteria in the remaining 10 patients (6%). In group 2, NSHBP was all validated by both criteria. Among the 192 patients with NSHBP, the shortest CL (318 ± 29 ms; range 270-470 ms) with which a stimulus can be conducted along the His bundle was at least 20 ms longer than that of surrounding myocardium (264 ± 16 ms; range 250-330 ms) for each patient, suggesting potentially high sensitivity of the CL criteria. CONCLUSION:CL criteria can determine the types of cardiac pacing independently and can avoid misclassification by output criteria.
A simple and practical criterion for determining a failed His-bundle pacing.
Liang Yanchun,Wang Na,Yu Haibo,Xu Baige,Yan Xiaolei,Wu Min,Gao Yang,Liu Rong,Xu Guoqing,Li Zhenhui,He Jiaqi,Wang Zulu,Han Yaling
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
AIMS:To establish a simple criterion for determining a failed His-bundle pacing (HBP). This criterion states that if stimulus to QRS end interval is longer than His-bundle potential to QRS end interval ('S-QRSend > H-QRSend') then a failed HBP can be determined. METHODS AND RESULTS:We performed retrospective analysis on 737 pacing tests around His-bundle in 241 patients and prospective analysis on 400 tests in 123 patients. A successful HBP is defined as that whole His-bundle is captured with or without capture of adjacent ventricular myocardium, otherwise, a failed HBP was considered. The output criteria and effective refractory period criteria were used as the gold standards for determining a successful HBP. The gold standards are that if decreasing the pacing output or pacing cycle length to a certain level results in duration or morphology changes of QRS, then a successful HBP is ascertained. In retrospective analysis of patients with normal His-Purkinje conduction, a failed HBP was determined in 31% (154/492) of pacing tests according to 'S-QRSend > H-QRSend'; all of them were validated by the gold standards (specificity = 100%). In prospective study, a failed HBP was confirmed according to the simple criterion with 100% accuracy in 33% (79/241) pacing tests. This simple criterion was also suitable for patients with His-Purkinje conduction disease although cases with 'S-QRSend > H-QRSend' rarely occurred. CONCLUSION:A failed HBP can be easily and reliably determined solely by 'S-QRSend > H-QRSend' in more than 30% pacing tests.