The V6-V1 Interpeak Interval: A Novel Criterion for the Diagnosis of Left Bundle Branch Capture

Overview

• Research Focus: Investigates the differences in ventricular activation patterns during left bundle branch (LBB) area pacing using the V6-V1 interpeak interval.
• Objective: Differentiate types of LBB area capture: non-selective (ns-) LBB, selective (s-) LBB, and left ventricular septal (LVS).
• Authors: Marek Jastrzebski et al.

Key Definitions

• RWPT (R-wave peak time): Time from the onset of the QRS complex to the peak of the R wave, measured in ECG leads V1 and V6.
• V6-V1 Interpeak Interval: Time difference of RWPT between leads V6 and V1.

Methods

• Participants: 468 patients screened; 124 patients included (239 ECGs analyzed).
• Measurements: Analysis of V6-V1 interpeak intervals, V6RWPT, and V1RWPT.

Results

• Loss of LVS capture -> 15 ms increase in V1RWPT, no change in V6RWPT.
• Loss of LBB capture -> 15 ms increase in V6RWPT, minimal effect on V1RWPT.
• V6-V1 interval times:
  • Longest during s-LBB capture: 62.3 ± 21.4 ms
  • Intermediate during ns-LBB capture: 41.3 ± 14.0 ms
  • Shortest during LVS capture: 26.5 ± 8.6 ms
• Optimal V6-V1 interval cut-off for ns-LBB vs. LVS capture: 33 ms.
• Specificity of 100% for LBB capture diagnosis at >44 ms cut-off.

Conclusion

• V6-V1 Interpeak Interval: Promising criterion for diagnosing LBB area capture.

Visual Aids

1. Figure 1: Illustrates ventricular activation patterns and effects of LBB capture transitions on ECG.
2. Figure 2: Shows three types of LBB area capture during pacing in the same patient.
3. Figure 3: ROC curve depicting diagnostic cut-off points for the V6-V1 interval.
4. Figure 4: Displays distribution of V6-V1 values across capture types.
5. Figure 5: Shows V6RWPT values in different V6-V1 interval groups.
6. Figure 6: Depicts impact of native QRS types on ECG measurements.

Additional Resources

• Full Text Sources: Available on Europe PubMed Central, PubMed Central, and Silverchair Information Systems.
• Related Articles: Listed for further reading on LBB capture and pacing.

MeSH Terms

• Focus on electrocardiographic features, pacing methods, and cardiac resynchronization.

This summary captures the essential findings and implications of the study on the V6-V1 interpeak interval as a diagnostic tool for LBB capture during pacing procedures.