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Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference
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  • Marek Jastrzebski,
  • Pawel Moskal,
  • Piotr Kukla,
  • Agnieszka Bednarek,
  • Grzegorz Kielbasa,
  • Marek Rajzer,
  • Karol Curila,
  • Pugazhendhi Vijayaraman
Marek Jastrzebski
Jagiellonian University Collegium Medicum
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Pawel Moskal
Jagiellonian University Collegium Medicum
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Piotr Kukla
Specialistic Hospital
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Agnieszka Bednarek
Jagiellonian University Collegium Medicum
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Grzegorz Kielbasa
Jagiellonian University Collegium Medicum
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Marek Rajzer
Jagiellonian University Collegium Medicum
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Karol Curila
, Charles University and University Hospital Kralovske Vinohrady
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Pugazhendhi Vijayaraman
Geisinger Heart institute
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Abstract

Background: During non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction. Methods: Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. Results: A total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. Conclusions: We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

Peer review status:ACCEPTED

17 Jun 2021Submitted to Journal of Cardiovascular Electrophysiology
28 Jun 2021Submission Checks Completed
28 Jun 2021Assigned to Editor
29 Jun 2021Reviewer(s) Assigned
19 Jul 2021Review(s) Completed, Editorial Evaluation Pending
21 Jul 2021Editorial Decision: Revise Minor
28 Jul 20211st Revision Received
28 Jul 2021Submission Checks Completed
28 Jul 2021Assigned to Editor
28 Jul 2021Reviewer(s) Assigned
16 Aug 2021Review(s) Completed, Editorial Evaluation Pending
24 Aug 2021Editorial Decision: Accept