ABSTRACT
BACKGROUND: Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles. OBJECTIVE: We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system. METHODS: In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters. RESULTS: One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced. CONCLUSIONS: LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.
Subject(s)
Defibrillators, Implantable , Humans , Child , Death, Sudden, Cardiac/prevention & control , Male , FemaleABSTRACT
Los inhibidores de la vitamina K han sido los fármacos más eficaces en el tratamiento anticoagulante de la fibrilación auricular durante las últimas décadas. Su abordaje presenta muchos incovenientes, que han hecho aunar los esfuerzos en el diseño de nuevas moléculas. Dabigatrán, rivaroxabán y, próximamente, apixabán, están disponibles en el mercado como alternativa al acenocumarol. Todos ellos han demostrado una eficacia al menos similar a warfarina en la prevención del ictus y fenómenos embólicos, y dabigatrán 150 mg y apixabán, incluso superior. Todo ello con un perfil de seguridad mejor, especialmente en lo que a hemorragias graves/fatales e intracraneales se refiere. Esto supone una verdadera revolución. El avance de estos nuevos anticoagulantes únicamente va a estar limitado por el mayor coste económico, ya que de un modo progresivo probablemente pasen a ser los protagonistas de la anticoagulación oral en los pacientes con fibrilación auricular de origen no valvular (AU)
The vitamin K inhibitors have been the most effective drugs for anticoagulant treatment of atrial fibrillation during the last decades. His approach has many drawbacks , which combine the efforts made in the design of new molecules. Dabigatran , rivaroxaban and soon apixaban , are available in the market as an alternative to warfarin. They have demonstrated efficacy at least similar to warfarin in preventing stroke and embolic phenomena , and 150 mg dabigatran and apixaban even higher. All this with a better safety profile , especially in serious / fatal and intracranial bleeding concerns . This is a real revolution. The progress of these new anticoagulants will only be limited by the higher cost because of a progressively likely to become the protagonists of oral anticoagulation in patients with atrial fibrillation of nonvalvular origin (AU)
Subject(s)
Humans , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Stroke/prevention & control , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Adenoma/complications , Adenoma/diagnosis , Carcinoma, Papillary/complications , Heart Failure/complications , Heart Neoplasms/complications , Heart Neoplasms/diagnosis , Heart Neoplasms/physiopathology , Heart NeoplasmsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Thrombosis/complications , Thrombosis/diagnosis , Chest Pain/etiology , Electrocardiography , Aspirin/therapeutic use , Echocardiography/methods , Thrombosis/drug therapy , ThrombosisABSTRACT
No disponible
No disponible