Imperial College London
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Dr Fu Siong Ng

Faculty of Medicine, National Heart & Lung Institute

Reader in Cardiac Electrophysiology
 
 
 
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Contact

 

+44 (0)20 7594 3614f.ng Website

 
 
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Location

 

430ICTEM buildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Ali:2023:europace/euad264,
author = {Ali, N and Saqi, K and Arnold, AD and Miyazawa, AA and Keene, D and Chow, J-J and Little, I and Peters, NS and Kanagaratnam, P and Qureshi, N and Ng, FS and Linton, NWF and Lefroy, DC and Francis, DP and Boon, Lim P and Tanner, MA and Muthumala, A and Agarwal, G and Shun-Shin, MJ and Cole, GD and Whinnett, ZI},
doi = {europace/euad264},
journal = {Europace},
title = {Left bundle branch pacing with and without anodal capture: impact on ventricular activation pattern and acute haemodynamics.},
url = {http://dx.doi.org/10.1093/europace/euad264},
volume = {25},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - AIMS: Left bundle branch pacing (LBBP) can deliver physiological left ventricular activation, but typically at the cost of delayed right ventricular (RV) activation. Right ventricular activation can be advanced through anodal capture, but there is uncertainty regarding the mechanism by which this is achieved, and it is not known whether this produces haemodynamic benefit. METHODS AND RESULTS: We recruited patients with LBBP leads in whom anodal capture eliminated the terminal R-wave in lead V1. Ventricular activation pattern, timing, and high-precision acute haemodynamic response were studied during LBBP with and without anodal capture. We recruited 21 patients with a mean age of 67 years, of whom 14 were males. We measured electrocardiogram timings and haemodynamics in all patients, and in 16, we also performed non-invasive mapping. Ventricular epicardial propagation maps demonstrated that RV septal myocardial capture, rather than right bundle capture, was the mechanism for earlier RV activation. With anodal capture, QRS duration and total ventricular activation times were shorter (116 ± 12 vs. 129 ± 14ms, P < 0.01 and 83 ± 18 vs. 90 ± 15ms, P = 0.01). This required higher outputs (3.6 ± 1.9 vs. 0.6 ± 0.2V, P < 0.01) but without additional haemodynamic benefit (mean difference -0.2 ± 3.8mmHg compared with pacing without anodal capture, P = 0.2). CONCLUSION: Left bundle branch pacing with anodal capture advances RV activation by stimulating the RV septal myocardium. However, this requires higher outputs and does not improve acute haemodynamics. Aiming for anodal capture may therefore not be necessary.
AU  - Ali,N
AU  - Saqi,K
AU  - Arnold,AD
AU  - Miyazawa,AA
AU  - Keene,D
AU  - Chow,J-J
AU  - Little,I
AU  - Peters,NS
AU  - Kanagaratnam,P
AU  - Qureshi,N
AU  - Ng,FS
AU  - Linton,NWF
AU  - Lefroy,DC
AU  - Francis,DP
AU  - Boon,Lim P
AU  - Tanner,MA
AU  - Muthumala,A
AU  - Agarwal,G
AU  - Shun-Shin,MJ
AU  - Cole,GD
AU  - Whinnett,ZI
DO  - europace/euad264
PY  - 2023///
TI  - Left bundle branch pacing with and without anodal capture: impact on ventricular activation pattern and acute haemodynamics.
T2  - Europace
UR  - http://dx.doi.org/10.1093/europace/euad264
UR  - https://www.ncbi.nlm.nih.gov/pubmed/37815462
VL  - 25
ER  -
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