Pacing and clinical electrophysiology : PACE · 2026
Sex-Based Differences in Left Bundle Branch Capture During Left Bundle Branch Area Pacing.
СтатьяНазвание и аннотация: Перевод в очереди
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Shadrin Ilya Y, Coles Sara A, Graff Claus, Al-Khatib Sana M, Loring Zak, Piccini Jonathan P, Sun Albert Y, Daubert James P, Hegland Donald D, Frazier-Mills Camille G, Pokorney Sean D, Jackson Kevin P, Atwater Brett D, Friedman Daniel J
Аннотация
OBJECTIVE: To identify sex-based differences in meeting left bundle branch (LBB) capture criteria on postimplant ECGs.
BACKGROUND: Despite differences in QRS duration (QRSd) between males and females, no sex-based criteria have been established for defining LBB capture during LBB area pacing (LBBAP).
METHODS: Patients aged >18 y.o. with a pacing indication and dual-chamber LBBAP pacemaker implantation from 2020 to 2023 were studied. Baseline and postoperative day 1 (POD1) ECGs were assessed for electrical dyssynchrony (QRS-area, sum-absolute integral of QRS-T (SAI QRS-T)), with LBB capture defined based on R-wave peak times (RWPT) per the EHRA 2023 Consensus algorithm.
RESULTS: The cohort included 222 patients (143 males/79 females, age 74.5±1.1 years, LVEF 53.7±0.4%). Baseline QRSd was significantly shorter among females than males (median 122 ms [90,134] vs 126 ms [102,146]; p = 0.018). LBB capture criteria were met in 83 (58.0%) male and 56 (70.9%) female patients (p = 0.058). Baseline and POD1 dyssynchrony were similar between sexes. However, RWPTs measured in leads V6/I/aVL were ∼7 ms shorter in females than males (V6-RWPT: 66.3 ± 1.6 ms vs. 73.7 ± 1.4 ms, p = 0.0008). Adjusting V6-RWPT up by 7 ms in females resulted in 7/56 patients (12.5%) no longer meeting LBB capture criteria. Significant differences were eliminated when normalizing RWPTs to size parameters (LV size, height, body surface area (BSA)), with no significant correlation between V6-RWPT and size.
CONCLUSIONS: Females with LBB capture exhibit shorter V6-RWPTs despite similar measures of electrical dyssynchrony. This difference disappears when normalizing for the smaller size of female hearts. Additional studies are warranted to establish sex-specific LBB capture criteria.
BACKGROUND: Despite differences in QRS duration (QRSd) between males and females, no sex-based criteria have been established for defining LBB capture during LBB area pacing (LBBAP).
METHODS: Patients aged >18 y.o. with a pacing indication and dual-chamber LBBAP pacemaker implantation from 2020 to 2023 were studied. Baseline and postoperative day 1 (POD1) ECGs were assessed for electrical dyssynchrony (QRS-area, sum-absolute integral of QRS-T (SAI QRS-T)), with LBB capture defined based on R-wave peak times (RWPT) per the EHRA 2023 Consensus algorithm.
RESULTS: The cohort included 222 patients (143 males/79 females, age 74.5±1.1 years, LVEF 53.7±0.4%). Baseline QRSd was significantly shorter among females than males (median 122 ms [90,134] vs 126 ms [102,146]; p = 0.018). LBB capture criteria were met in 83 (58.0%) male and 56 (70.9%) female patients (p = 0.058). Baseline and POD1 dyssynchrony were similar between sexes. However, RWPTs measured in leads V6/I/aVL were ∼7 ms shorter in females than males (V6-RWPT: 66.3 ± 1.6 ms vs. 73.7 ± 1.4 ms, p = 0.0008). Adjusting V6-RWPT up by 7 ms in females resulted in 7/56 patients (12.5%) no longer meeting LBB capture criteria. Significant differences were eliminated when normalizing RWPTs to size parameters (LV size, height, body surface area (BSA)), with no significant correlation between V6-RWPT and size.
CONCLUSIONS: Females with LBB capture exhibit shorter V6-RWPTs despite similar measures of electrical dyssynchrony. This difference disappears when normalizing for the smaller size of female hearts. Additional studies are warranted to establish sex-specific LBB capture criteria.