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Electrocardiographic patterns predictive of left bundle branch block correction with His bundle pacing
Author(s) -
MoriñaVázquez Pablo,
MoraledaSalas Maria Teresa,
ArceLeón Álvaro,
FernándezGómez Juan Manuel,
VenegasGamero José,
DíazFernández José Francisco
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14021
Subject(s) - medicine , left bundle branch block , cardiology , qrs complex , cardiac resynchronization therapy , bundle , predictive value , electrocardiography , bundle branch block , heart failure , ejection fraction , materials science , composite material
Permanent His bundle pacing (p‐HBP) could be an alternative for traditional cardiac resynchronization therapy (CRT), but an important limitation is that p‐HBP cannot always correct the left bundle branch block (LBBB). The purpose of this article is to assess electrocardiographic patterns of LBBB that can predict electrocardiographic response (QRS narrowing) to His bundle pacing. Methods We designed a prospective descriptive study of patients with LBBB and CRT indication proposed for CRT by p‐HBP. We analyzed the correlation between the different electrocardiographic patterns and the correction of conduction disturbance (LBBB). Results We included 70 patients. Pacing at the location where His bundle electrogram was recorded narrowed the QRS in 81.4% (n = 57). Basically, we identified two electrocardiographic patterns in lead V1: QS or rS. The QS pattern was a sensitivity of 56%, a specificity of 84.6%, and a positive predictive value (PPV) of 94.1% to predict the correction of the LBBB (area under the curve [AUC] = .70). In patients with rS pattern, a ratio between the descending and the ascending S wave component duration ≥0.64 was a very good predictor of the correction of the LBBB (AUC = .968); with a value ≥0.64, the sensitivity, specificity, and PPV was 92%, 100%, and 100%, respectively. Conclusions In patients with LBBB and CRT indication, the QS pattern in lead V1 predicts the correction of the QRS with HBP. In the case of rS pattern in lead V1, the ratio descending/ascending S wave component duration has a strong correlation with the LBBB correction.