Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing

Kód výsledku v 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>

Nalezeny alternativní kódy

RIV/00216208:11120/25:43928277

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing

Popis výsledku v původním jazyce

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&apos;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&apos;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.

Název v anglickém jazyce

Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing

Popis výsledku anglicky

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&apos;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&apos;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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Heart Rhythm

ISSN

1547-5271

e-ISSN

1556-3871

Svazek periodika

22

Číslo periodika v rámci svazku

12

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

10

Strana od-do

3218-3227

Kód UT WoS článku

001630638600020

EID výsledku v databázi Scopus

2-s2.0-105002302676