Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing
The result's identifiers
Result code in IS VaVaI
<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F25%3A43928277" target="_blank" >RIV/00064173:_____/25:43928277 - isvavai.cz</a>
Alternative codes found
RIV/00216208:11120/25:43928277
Result on the web
<a href="https://doi.org/10.1016/j.hrthm.2025.03.1959" target="_blank" >https://doi.org/10.1016/j.hrthm.2025.03.1959</a>
DOI - Digital Object Identifier
<a href="http://dx.doi.org/10.1016/j.hrthm.2025.03.1959" target="_blank" >10.1016/j.hrthm.2025.03.1959</a>
Alternative languages
Result language
angličtina
Original language name
Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing
Original language description
BACKGROUND: Determining capture type and septal lead location during left bundle branch area pacing (LBBAP) relies on criteria obtained during implantation. However, during follow-up, the interpretation of left bundle branch (LBB) capture largely depends on QRS morphology, which is not so straightforward in LBBAP. OBJECTIVE: To investigate the inter- and intra-observer agreement, as well as the accuracy of clinical judgment of the ECG in determining LBB-capture and septal lead position in patients undergoing LBBAP implantation. In addition, the role of vectorcardiographic QRS-area in determining LBB-capture was evaluated. METHODS: Unipolar paced ECGs during LBBAP implantation from 50 patients with baseline narrow QRS were collected. LBB-capture was attempted in all patients and assessed using MELOS-criteria and the EHRA consensus-statement. Eight blinded cardiologists classified 100 ECGs for capture type and septal location. RESULTS: The inter-observer and intra-observer agreement for capture type had a Light's kappa of 0.43 and 0.62 respectively. Concordance between clinical judgment and intra-procedural confirmation averaged 72%. Inter-observer and intra-observer agreement for septal lead position had a Light's kappa of 0.43 and 0.77 respectively. QRS-area was significantly higher for LVSP than nsLBBP, while QRS duration was not. A QRS-area cutoff of 26 mV.ms had 77% accuracy in distinguishing LVSP from nsLBBP. Clinical judgment accuracy averaged 72%. CONCLUSION: Inter-observer agreement and correlation with intraprocedural confirmation (gold standard) are only moderate, while intra-observer agreement on ECG-based differentiation of capture type and septal lead location is substantial. Vectorcardiographic QRS-area slightly outperforms clinical judgment in distinguishing capture types and may be a useful objective alternative.
Czech name
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Czech description
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Classification
Type
J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database
CEP classification
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OECD FORD branch
30201 - Cardiac and Cardiovascular systems
Result continuities
Project
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Continuities
N - Vyzkumna aktivita podporovana z neverejnych zdroju
Others
Publication year
2025
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Heart Rhythm
ISSN
1547-5271
e-ISSN
1556-3871
Volume of the periodical
22
Issue of the periodical within the volume
12
Country of publishing house
US - UNITED STATES
Number of pages
10
Pages from-to
3218-3227
UT code for WoS article
001630638600020
EID of the result in the Scopus database
2-s2.0-105002302676