Advertisement

Right bundle branch pacing: criteria, characteristics and outcomes

Published:January 22, 2023DOI:https://doi.org/10.1016/j.hrthm.2023.01.017

      Abstract

      Background

      Targets for right-sided conduction system pacing (CSP) include His bundle and right bundle branch. ECG patterns, diagnostic criteria and outcomes of right bundle branch pacing (RBBP) are not known.

      Objective

      Our aims were to delineate electrocardiographic and electrophysiological characteristics of RBBP and to compare outcomes between RBBP and His bundle pacing (HBP).

      Methods

      Patients with confirmed right CSP were divided according to the conduction system potential to QRS interval at the pacing lead implantation site. Six hypothesized RBBP criteria as well as pacing parameters, echocardiographic outcomes and all-cause mortality were analyzed.

      Results

      All analyzed criteria discriminated between HBP and RBBP: double QRS transition during threshold test, selective paced QRS different from conducted QRS, stimulus to selective QRS > potential-QRS, small increase in V6RWPT during QRS transition, equal capture thresholds of CSP and myocardium, and stimulus-V6 R-wave peak time (V6RWPT) > potential-V6RWPT (adopted as diagnostic standard). Per this last criterion, RBBP was observed in 19.2% (64/326) patients who had been targeted for HBP, present mainly among patients with potential to QRS < 35 ms (90.6%, 48/53) and occasionally in the remaining patients (5.6%, 16/273). RBBP was characterized by longer QRS (by 10.5 ms), longer V6RWPT (by 11.6 ms) and better sensing (by 2.6 mV) compared to HBP. During median follow-up of 29 months, no differences in capture threshold, echocardiographic outcomes or mortality were found.

      Conclusions

      RBBP has distinct features that separate it from HBP and is observed in approximately a fifth of patients in whom HBP is intended.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vijayaraman P.
        • Ponnusamy S.
        • Cano O.
        • et al.
        Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: Results From the International LBBAP Collaborative Study Group.
        JACC Clin Electrophysiol. 2021; 7: 135-147
        • Vijayaraman P.
        • Cano O.
        • Ponnusamy S.S.
        • et al.
        Left bundle branch area pacing in patients with heart failure and right bundle branch block: Results from International LBBAP Collaborative-Study Group.
        Heart Rhythm O2. 2022; 3: 358-367
        • Vijayaraman P.
        • Herweg B.
        • Verma A.
        • et al.
        Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing: Results from International LBBAP Collaborative Study Group.
        Heart Rhythm. 2022; 19: 1272-1280
        • Sharma P.S.
        • Dandamudi G.
        • Naperkowski A.
        • et al.
        Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice.
        Heart Rhythm. 2015; 12: 305-312
        • Jastrzebski M.
        • Moskal P.
        • Huybrechts W.
        • et al.
        Left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT): Results from an international LBBAP collaborative study group.
        Heart Rhythm. 2022; 19: 13-21
        • Jastrzebski M.
        • Kielbasa G.
        • Cano O.
        • et al.
        Left bundle branch area pacing outcomes: the multicentre European MELOS study.
        Eur Heart J. 2022;
        • Jastrzebski M.
        • Kielbasa G.
        • Curila K.
        • et al.
        Physiology-based electrocardiographic criteria for left bundle branch capture.
        Heart Rhythm. 2021; 18: 935-943
      1. Jastrzebski M, Moskal P, Kukla P, M et al. Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference. J Cardiovasc Electrophysiol 2021;32:3010-3018.

        • Jastrzebski M.
        ECG and Pacing Criteria for Differentiating Conduction System Pacing from Myocardial Pacing.
        Arrhythm Electrophysiol Rev. 2021; 10: 172-180
        • Burri H.
        • Jastrzebski M.
        • Vijayaraman P.
        Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow-Up.
        JACC Clin Electrophysiol. 2020; 6: 883-900
      2. Castellanos A, Jr. H-V intervals in LBBB. Circulation 1973;47:1133-1134.

        • Durrer D.
        • van Dam R.T.
        • Freud G.E.
        • Janse M.J.
        • Meijler F.L.
        • Arzbaecher R.C.
        Total excitation of the isolated human heart.
        Circulation. 1970; 41: 899-912
      3. Josephson ME. Intraventricular conduction disturbances. In: Josephson ME, editor. Clinical Cardiac Electrophysiology. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 126.

        • Burri H.
        Fortuitous distal right bundle branch pacing.
        Heart Rhythm Case Reports. 2022; (in press)
        • Vijayaraman P.
        Simultaneous Right and Left Bundle Pacing for Cardiac Resynchronization Therapy.
        JACC Clin Electrophysiol. 2022; 8: 138-140