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Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography

BACKGROUND: Left bundle branch (LBB) pacing (LBBP) has recently emerged as a physiological pacing mode. Current of injury (COI) can be used as the basis for electrode fixation position and detection of perforation. However, because the intermittent pacing method cannot monitor the changes in COI in...

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Autores principales: Shen, Jiabo, Jiang, Longfu, Wu, Hao, Li, Hengdong, Zhong, Jinyan, Pan, Lifang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681806/
https://www.ncbi.nlm.nih.gov/pubmed/36440050
http://dx.doi.org/10.3389/fcvm.2022.1025620
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author Shen, Jiabo
Jiang, Longfu
Wu, Hao
Li, Hengdong
Zhong, Jinyan
Pan, Lifang
author_facet Shen, Jiabo
Jiang, Longfu
Wu, Hao
Li, Hengdong
Zhong, Jinyan
Pan, Lifang
author_sort Shen, Jiabo
collection PubMed
description BACKGROUND: Left bundle branch (LBB) pacing (LBBP) has recently emerged as a physiological pacing mode. Current of injury (COI) can be used as the basis for electrode fixation position and detection of perforation. However, because the intermittent pacing method cannot monitor the changes in COI in real time, it cannot obtain information about the entire COI change process during implantation. CASE SUMMARY: Left bundle branch pacing was achieved for treatment of atrioventricular block in a 76-year-old female. Uninterrupted electrocardiogram and electrogram were recorded on an electrophysiology system. In contrast to the interrupted pacing method, this continuous pacing and recording technique enables real-time monitoring of the change in ventricular COI and the paced QRS complex as the lead advances into the interventricular septum. During the entire screw-in process, the COI amplitude increased and then decreased gradually after reaching the peak, followed by a small but significant, rather than dramatic, decrease. CONCLUSION: This case report aims to demonstrate the clinical significance of changes in COI and QRS morphology for LBBP using real-time electrocardiographic monitoring and filtered and unfiltered electrograms when the lead is deployed using a continuous pacing technique. The technique could be used to confirm LBB capture and avoid perforation.
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spelling pubmed-96818062022-11-24 Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography Shen, Jiabo Jiang, Longfu Wu, Hao Li, Hengdong Zhong, Jinyan Pan, Lifang Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Left bundle branch (LBB) pacing (LBBP) has recently emerged as a physiological pacing mode. Current of injury (COI) can be used as the basis for electrode fixation position and detection of perforation. However, because the intermittent pacing method cannot monitor the changes in COI in real time, it cannot obtain information about the entire COI change process during implantation. CASE SUMMARY: Left bundle branch pacing was achieved for treatment of atrioventricular block in a 76-year-old female. Uninterrupted electrocardiogram and electrogram were recorded on an electrophysiology system. In contrast to the interrupted pacing method, this continuous pacing and recording technique enables real-time monitoring of the change in ventricular COI and the paced QRS complex as the lead advances into the interventricular septum. During the entire screw-in process, the COI amplitude increased and then decreased gradually after reaching the peak, followed by a small but significant, rather than dramatic, decrease. CONCLUSION: This case report aims to demonstrate the clinical significance of changes in COI and QRS morphology for LBBP using real-time electrocardiographic monitoring and filtered and unfiltered electrograms when the lead is deployed using a continuous pacing technique. The technique could be used to confirm LBB capture and avoid perforation. Frontiers Media S.A. 2022-11-09 /pmc/articles/PMC9681806/ /pubmed/36440050 http://dx.doi.org/10.3389/fcvm.2022.1025620 Text en Copyright © 2022 Shen, Jiang, Wu, Li, Zhong and Pan. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Shen, Jiabo
Jiang, Longfu
Wu, Hao
Li, Hengdong
Zhong, Jinyan
Pan, Lifang
Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title_full Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title_fullStr Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title_full_unstemmed Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title_short Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
title_sort case report: left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681806/
https://www.ncbi.nlm.nih.gov/pubmed/36440050
http://dx.doi.org/10.3389/fcvm.2022.1025620
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