ECG characteristics of “true” left bundle branch block: Insights from transcatheter aortic valve–related LBBB and His-Purkinje conduction system pacing–correctable LBBB

Iwanari Kawamura, Syeda Atiqa Batul, Pugazhendhi Vijayaraman, Brandon Needelman, Alex Choy, Jake Martinez, Roderick Tung, Sahil Khera, Annapoorna Kini, Samin Sharma, Vivek Y. Reddy, Jacob S. Koruth

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Left bundle branch block (LBBB) pattern on the electrocardiogram includes patients with both complete conduction block in the His-Purkinje system as well as nonspecific left ventricular conduction delay without discrete block. Objective: The purpose of this study was to characterize electrocardiographic morphological features of LBBB patterns in patients with (1) LBBB after transcatheter aortic valve replacement (TAVR) and (2) LBBB correctable by conduction system pacing (CSP). Methods: Consecutive patients with post-TAVR (n = 123) or CSP-correctable LBBB (n = 58) from 2 centers were included in this retrospective evaluation. QRS durations as well as detailed morphological features, including notching and slurring, of QRS complexes in leads I, aVL, V1, V2, V5, and V6 and in all 3 inferior leads were recorded. Results: The mean age of the entire cohort was 78.3 ± 10.1 years, with 48% of the cohort being male (87/181). In the CSP-correctable group (n = 58), 14 (24.1%) underwent His-bundle pacing and 44 (75.9%) left bundle branch area pacing. A total of 17 of 181 (9.4%) of the combined cohort failed to completely meet the Strauss criteria. QRS morphology in lead V1/V2 was always either rS or QS, and there were no q/Q waves noted in lead V5/V6. Although dominant R waves were seen in leads I and aVL of 176 of 181 (97.2%), q/Q waves were present in only 21 of 181 (11.6%). Importantly, notched or slurred QRS complexes were identified in at least 1 lead of 4 leads I, aVL, V5, and V6 in 181 of 181 (100%). Conclusion: Strauss criteria and QRS notching are highly prevalent in LBBB after TAVR and in LBBB correctable by CSP.

Original languageEnglish
Pages (from-to)1659-1666
Number of pages8
JournalHeart Rhythm
Volume20
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • Cardiac resynchronization therapy
  • Conduction system pacing
  • Heart failure
  • His bundle pacing
  • Left bundle branch block
  • Left bundle branch pacing

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