ECG in Conduction System Pacing: An Essential Tool for Success?-ECG in Conduction System Pacing: An Essential Tool for Success?

Video Transcription

Video Summary

The main message from the presentation is that electrograms can provide valuable information for diagnosing and troubleshooting conduction system pacing. In his bundle pacing, different patterns of ECG can indicate selective or non-selective capture of the conduction system fibers. The presence of a slurred upstroke or delta wave can indicate non-selective capture, while a normal QRS morphology with no slurs or notches may indicate selective capture. The R-wave peak time in lead V6 can also be used to differentiate between non-selective his bundle capture and myocardial capture. An R-wave peak time of less than 100 milliseconds suggests his bundle capture, while an R-wave peak time of more than 100 milliseconds suggests myocardial capture. In LV septal pacing, the ECG morphology can vary depending on whether the proximal main bundle or one of its pre-cursor fascicles is being captured. Changes in QRS morphology, duration, and axis can indicate transitions between different types of capture. To differentiate non-selective his bundle pacing from myocardial pacing, the R-wave peak time in lead V6 can be measured. An R-wave peak time less than 100 milliseconds suggests non-selective his bundle capture, while an R-wave peak time more than 100 milliseconds suggests myocardial capture. In addition to electrograms, other techniques such as body surface mapping and ultra-high frequency ECG can also be used to assess and optimize conduction system pacing. Electrocardiographic imaging can provide detailed maps of cardiac activation, helping to visualize and confirm resynchronization. Ultra-high frequency ECG can assess the timing and synchronization of ventricular activation, helping to refine pacing parameters and improve outcomes. These tools can be valuable in patient selection, pre-implant optimization, and follow-up of conduction system pacing. Overall, a thorough understanding of electrograms and other diagnostic techniques is essential for troubleshooting and optimizing conduction system pacing.

Keywords

electrograms

diagnosing

troubleshooting

conduction system pacing

his bundle pacing

ECG patterns

selective capture

non-selective capture

QRS morphology

R-wave peak time