Ventricular depolarization and dyssynchrony in conduction system pacing vs conventional pacing by ultra-high-frequency-ECG
J M Carreno Lineros, I Esteve Ruiz, T Moraleda Salas, A Arce Leon, E Amigo Otero, P Morina VazquezAbstract
Background
Ultra-high-frequency electrocardiography(UHF-ECG) is a novel method to analyze the time sequence of ventricular depolarization, allowing to assess ventricular electrical dyssinchrony.
Purpose
We aimed to compare the synchrony parameters associated with differents ventricular lead locations, both in conventional pacing and conduction sistem pacing (CSP).
Methods
We prospectively recruited consecutive patients with permanent pacemaker indication. We sequentially assessed in each patient the characteristics of ventricular depolarization using ECG data and UHF-ECG data in different lead positions: right ventricle apex (RVA), right ventricle outflow tract (RVOT), RV septum (RVS) or parahisian septum (PHS); and posteriorly, His bundle (HB) or left bundle branch area (LBBA). We compared non-physiological and physiological pacing, and specific leads locations.
Results
We included 39 patients with a variety of PM indications. The mean age was 77 [72-81] years and the mean basal QRS was 146 ±27,4 ms. Interventricular dyssynchrony (IVD) was assessed by the e-Dys16 parameter, which was significantly shorter (reflecting better IV synchrony) with CSP (12±19 vs 38±37 ms), and by VED16, also shorter in CSP (12±25 vs 34±40 ms). Mean duration of local ventricular depolarization (MeanVD16) was shorter in CSP (50±12 vs 67±14 ms). All results reached significancy (p<0,05). Among conventional lead locations, RVS and PHS showed significantly shorter QRS and RWPT in V6, and shorter ventricular depolarization duration (MeanVD16), but there were no differences in IVD (eDys16 and VED16). Among CSP modalities, HBP reached better values of ventricular depolarization duration (MeanVD16 48±13 vs 57±11 ms; p=.008) than LBBAP, without significant differences in parameters of IVD.
Conclusions
Physiological pacing methods were related whith better dyssinchrony parameters than conventional non-physiological methods. RVS and PHS showed some electrical advantages over other non-physiological lead placements. HBP seemed to achieve faster ventricular depolarization than LBBAP.Conventional vs CSPExample of UHF-EG