Template Beat

HomeCirculation: Arrhythmia and ElectrophysiologyVol. 14, No. 4Template Beat Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBTemplate BeatA Novel Marker for Left Bundle Branch Capture During Physiological Pacing Shunmuga Sundaram Ponnusamy, MD, Vithiya Ganesan, Thabish Syed, Suryakumar Balasubramanian, MBBS Pugazhendhi Vijayaraman, MD PonnusamyShunmuga Ponnusamy Correspondence to: DM, PDF, CEPS, Department of Cardiology, Velammal Village, Medical College Hospital Research Institute, Madurai 625009, Tamilnadu, India. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7059-425X Departments Cardiology (S.S.P., T.S., S.B.), College, Madurai, Tamil Nadu, Search more papers by this author , GanesanVithiya Ganesan Microbiology (V.G.), SyedThabish Syed https://orcid.org/0000-0002-3144-8655 BalasubramanianSuryakumar Balasubramanian VijayaramanPugazhendhi Vijayaraman https://orcid.org/0000-0003-2230-100X Geisinger Heart Wilkes Barre, PA (P.V.). Originally published16 Apr 2021https://doi.org/10.1161/CIRCEP.120.009677Circulation: Electrophysiology. 2021;14Other version(s) articleYou are viewing the most recent version article. Previous versions: April 16, 2021: Ahead Print pacing has witnessed a revolutionary growth in last decade. bundle branch (LBB) (LBBP), where direct capture proximal main left could be achieved at low threshold, overcome limitations His pacing.1,2 The criteria confirming LBB had been defined but never validated.3 We recently proposed novel method performing LBBP observing premature ventricular complexes (PVCs) generated during lead deployment.4 A PVC with right delay morphology (qR/rSR V1) QRS duration <130 ms would as reaches area. labeled template beat it mimicked paced (Figure [A]). Further rotations avoided if was noted rapid deployment. aimed analyzing incidence marker its clinical significance.Download figureDownload PowerPointFigure. Template beat–guided (LBBP).A, block (LBBB) correction LBBP. Rapid deployment resulted changing until is obtained. Final 98 after atrioventricular optimization. B, patient LBBB dysfunction. Nonselective selective transition demonstrated near threshold output, final 100 ms. C, complete heart block. Initial 4 turns QS pattern PVCs, which site. Few were given till appearance beat, matched morphology. 110 T-wave memory. HB indicates bundle; LAO, anterior-oblique; LBB, branch; RV, ventricle.This prospective observational study that included 90 consecutive patients who undergone successful using C315-sheath 3830 Selectsecure (Medtronic, Minneapolis). approved institutional review board, gave informed consent. Continuous deploy septum If there no PVCs deployment, placement decided on morphology, unipolar impedance, peak activation time. data support findings available from corresponding upon reasonable request.The population divided into 2 groups based occurrence deployment: group I (n=53; 59%) II without (n=37; 41%). Female higher (67%) beat. There difference septal thickness, basal duration, ejection fraction both groups. depth inside 10.3±2.1 mm 10.5±2.1 (P=0.67). Both LBB. No developed perforation implantation, 8 (0% versus 21.6%; P=0.004). [A–C]).The fluoroscopy time total significantly less compared (14.5±7.8 20.4±14.2 minutes, P=0.04, 19.7±9.9 26.3±16.6 P=0.02). Only opposed slow gradual impedance monitoring each set rotations. Cardiac magnetic resonance imaging not done all patients, have documented late gadolinium enhancement one reasons progression movement septum. beats showed mean 121.1±3.7 interrupted some reason narrow PVC, additional observed [C]).Paced interval optimization (108.9±8.3 116.1±13.3 ms; P=0.002). trend toward better Tpeak-Tend/QTc ratio (0.18±0.03 0.19±0.02; P=0.08) (68.3±13.8 73.6±13.1 P=0.07) I. Peak cTnI (cardiac troponin-I) measured procedure (232.9±373.5 123.1±106.1 pg/mL; P=0.04 [independent samples t test]), indicating myocardial injury PVC-guided deployment.The our (1) 58% can considered capture; (2) predicts time, shorter time; (3) confer minimal avoid deployment.It may difficult confirm conduction system published patients. (template beat)-guided help confirms Purkinje fibers due mechanical trauma induced moves rapidly area.4 In presence scar, penetration possible seen. This might result repeated attempts positioning increase release myocardium. Avoiding further once prevent septum, resulting perforation.LBBP emerging an alternative pacing. safe area, avoiding perforation, minimizing damage. studies required validate technique criterion capture.Sources FundingNone.Disclosures Dr received honoraria Medtronic. honoraria, consulting fees, research form Medtronic fees Boston Scientific, Abbott, Biotronik, Eaglepoint. other authors report conflicts.FootnotesFor Sources Funding Disclosures, see page 450.Correspondence shunmuga.[email protected]comReferences1. Huang W, Chen X, Su L, Wu S, Xia P. beginner’s guide permanent pacing.Heart Rhythm. 2019; 16:1791–1796. doi: 10.1016/j.hrthm.2019.06.016CrossrefMedlineGoogle Scholar2. SS, Arora V, Namboodiri N, Kumar Kapoor A, pacing: comprehensive review.J Cardiovasc Electrophysiol. 2020; 31:2462–2473. 10.1111/jce.14681CrossrefMedlineGoogle Scholar3. P, Cano Ó, Sharma PS, Naperkowski Subsposh FA, Moskal Bednarek Dal Forno AR, Young et al. area cardiac resynchronization therapy: results International LBBAP Collaborative Study Group.JACC Clin 2021; 7:135–147. 10.1016/j.jacep.2020.08.015CrossrefMedlineGoogle Scholar4. guided implant.HeartRhythm Case Rep. 6:850–853. 10.1016/j.hrcr.2020.08.010CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetailsCited By Herweg Verma Batul Schaller R, O, Molina-Lerma M, Curila K, Huybrechts Wilson D, Rademakers Sreekumar Upadhyay G, Vernooy Subzposh F, Jastrzebski M Ellenbogen K (2022) Rescue coronary venous failure or nonresponse biventricular Results Group, Rhythm, 10.1016/j.hrthm.2022.04.024, Online publication date: 1-Apr-2022. Jastrz?bski implantation uninterrupted endocardial signals, Journal Cardiovascular Electrophysiology, 10.1111/jce.15427, 33:5, (1055-1057), 1-May-2022. S P (2021) Axis deviation nonischemic cardiomyopathy block: Insights pacing, 10.1111/jce.15334, 33:2, (318-321), 1-Feb-2022. T Response functional mitral regurgitation 10.1016/j.hrthm.2022.01.019, 19:5, (737-745), Basil W Electrophysiological characteristics 10.1016/j.hrthm.2022.01.018, (728-734), Rajzer branch–optimized therapy (LOT-CRT): international collaborative group, 10.1016/j.hrthm.2021.07.057, 19:1, (13-21), 1-Jan-2022. Evaluation Criteria Capture, Electrophysiology Clinics, 10.1016/j.ccep.2021.12.011, 14:2, (191-202), 1-Jun-2022. Optimized Resynchronization Therapy Mesocardia With Bilateral Superior Vena Cava, JACC: Clinical 10.1016/j.jacep.2021.09.005, 8:3, (406-409), 1-Mar-2022. Electroanatomical mapping assisted Indian Journal, 10.1016/j.ipej.2022.06.003, 22:4, (186-187), 1-Jul-2022. Electrocardiography Electrocardiology, 10.1016/j.jelectrocard.2021.07.001, 68, (11-13), 1-Sep-2021. Ó Area Pacing: Implant Technique, Definitions, Outcomes, Complications, Current Reports, 10.1007/s11886-021-01585-1, 23:11, 1-Nov-2021. How Leads: Tips Pearls, Failure Review, 10.15420/cfr.2021.04, 7 Shen J, Jiang H, Cai Zhuo Pan L Premature branch: reaching capturing branch, Interventional 10.1007/s10840-022-01203-2 M?beat—A capture, 10.1111/jce.15597 2021Vol Issue Advertisement Article InformationMetrics © 2021 American Association, Inc.https://doi.org/10.1161/CIRCEP.120.009677PMID: 33858179 publishedApril Keywordsbundle Hisventricular complexesincidencephysiologyheart systemPDF download SubjectsElectrophysiologyPacemaker