Data_Sheet_1_Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography.PDF

BackgroundLeft bundle branch (LBB) pacing (LBBP) has recently emerged as a physiological pacing mode. Current of injury (COI) can be used as the basis for electrode fixation position and detection of perforation. However, because the intermittent pacing method cannot monitor the changes in COI in real time, it cannot obtain information about the entire COI change process during implantation.Case summaryLeft bundle branch pacing was achieved for treatment of atrioventricular block in a 76-year-old female. Uninterrupted electrocardiogram and electrogram were recorded on an electrophysiology system. In contrast to the interrupted pacing method, this continuous pacing and recording technique enables real-time monitoring of the change in ventricular COI and the paced QRS complex as the lead advances into the interventricular septum. During the entire screw-in process, the COI amplitude increased and then decreased gradually after reaching the peak, followed by a small but significant, rather than dramatic, decrease.ConclusionThis case report aims to demonstrate the clinical significance of changes in COI and QRS morphology for LBBP using real-time electrocardiographic monitoring and filtered and unfiltered electrograms when the lead is deployed using a continuous pacing technique. The technique could be used to confirm LBB capture and avoid perforation.

背景：左侧束支（LBB）起搏（LBBP）作为一种生理性起搏模式，近年来已崭露头角。损伤电流（COI）可作为电极固定位置的基础，以及穿孔检测的依据。然而，由于间歇式起搏方法无法实时监测COI的变化，因此无法获取植入过程中COI整个变化过程的信息。案例摘要：为治疗一名76岁女性患者的房室传导阻滞，实现了左侧束支起搏。在电生理系统中记录了连续的心电图和电生理图。与间歇式起搏方法相比，这种连续起搏和记录技术能够实时监测随着电极进入心室间隔，心室COI的变化以及起搏的QRS复合波。在整个螺丝拧入过程中，COI幅度先增加后逐渐减小，达到峰值后，随之出现小幅但显著的，而非戏剧性的下降。结论：本案例报告旨在通过实时心电图监测以及使用连续起搏技术部署电极时的滤波和不滤波心电图的QRS形态变化，展示损伤电流（COI）变化在LBBP临床应用中的重要性。该技术可用于确认LBB起搏并避免穿孔。