axillary or subclavian vein puncture) were reserved for bail-out procedures. Cephalic vein access for all leads using a modified Seldinger technique was the standard approach. Vitamin K antagonists were generally not interrupted, and device implantation was performed if the international normalised ratio did not exceed 3.0. If patients were on direct oral anticoagulant therapy, treatment was interrupted 24 h before implantation. ProcedureĪll device implantations were performed with the patient under local anaesthesia after perioperative administration of 2 g intravenous cefazoline. All patients were on maximally tolerated heart failure medication for at least 3 months prior to device implantation. Patients were classified as having an ischaemic cardiomyopathy if they had had a previous myocardial infarction or revascularisation. Permanent atrial fibrillation was an exclusion criterion. Patients were required to be in sinus rhythm in order to be included in the study but were allowed to have a history of paroxysmal or persistent atrial fibrillation. In order to evaluate LBBP versus BVP, 40 consecutive patients with identical inclusion criteria who received BVP from January 2019 to September 2019 were retrospectively analysed and compared with the LBBP group. If LBBP was not satisfactory, BVP was performed as a bail-out procedure. The study protocol was approved by both our institutional ethics committee and an independent medical research ethics committee (MEC-U) with an in-hospital independent monitoring committee. Patients who refused LBBP received conventional BVP and were excluded from this study. Prior to the implantation procedure the operators discussed the non-standard but potentially more physiological nature of conduction system pacing with the patients, and all patients participating in this study provided informed consent. These patients were prospectively studied. LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.įrom January 2020 to September 2020, 40 consecutive patients who were in sinus rhythm with New York Heart Association (NYHA) class II–IV heart failure, reduced left ventricular ejection fraction (LVEF ≤ 35%) and complete LBBB according to the Strauss criteria with QRS > 140 ms in men and > 130 ms in women underwent attempted LBBP as the first-line method for delivering CRT. Hospitalisation for heart failure and all-cause mortality were similar in the two groups. LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. This study assessed the feasibility and outcomes of LBBP in comparison to BVP. The ECG in Acute MI.Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). ECG in Emergency Medicine and Acute Care 1e, 2004 ECG’s for the Emergency Physician Part I 1e, 2003 and Part II Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008 Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009 Marriott’s Practical Electrocardiography 13e, 2021 Electrocardiography in Emergency, Acute, and Critical Care. ECG Blue Belt online course: Learn to diagnose any rhythm problem. ECG Yellow Belt online course : Become an ECG expert. Not due to any of the causes above - Before making this diagnosis, be sure to check the serum potassium level and scrutinise the ECG for any signs of TCA toxicity.Arrhythmogenic right ventricular dysplasia (AVRD) – localised QRS widening in V1-2 plus epsilon waves and variable signs of right ventricular hypertrophy.Brugada syndrome – localised QRS widening in V1-2 with RBBB morphology.Wolff-Parkinson-White syndrome – wide QRS plus delta waves. TCA overdose) – wide QRS plus positive R’ wave in aVR. Causes of Intraventricular Conduction Delay Fascicular and bundle-branch blocks
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