ArticleCJC open2026
Delayed Stimulus to V6 R-Wave Peak Time for Selective Left Bundle Branch Pacing: Characteristics and Underlying Mechanisms.
Article in CJC open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
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Abstract
Background: Selective left bundle branch pacing (SLBBP) preserves left ventricular synchrony via low stable capture thresholds and shortened stimulus-to-V6 R-wave peak time (S-V6 RWPT), yet delayed S-V6 RWPT (DRWPT) occurs in some recipients. This study aimed to define DRWPT's electrocardiographic and intracardiac electrogram features during SLBBP and investigate its mechanisms. Methods: We retrospectively analyzed 368 SLBBP patients (September 2020 to November 2024, continuous monitoring), enrolled 11 with DRWPT as the study group, enrolled 33 with 1:3 matched shortened S-V6 RWPT (SRWPT) as controls, and analyzed electrocardiogram/intracardiac electrogram features with the isoelectric interval as the endpoint. Results: DRWPT was identified in 3% (11 of 368) of the cohort. Baseline pacing parameters in the DRWPT group were as follows: mean QRS duration 128 ± 35.4 ms, unipolar initial myocardial threshold 1.6 ± 0.7 V, initial left bundle branch threshold 0.7 ± 0.1 V, sensed R-wave amplitude 8.0 ± 2.6 mV, and pacing impedance of 644.1 ± 157.8 Ω. Compared with controls, the DRWPT group had a significantly higher right bundle branch block incidence (63.6% vs 6.06%, Conclusions: DRWPT, linked to impaired left bundle branch conduction with prolonged isoelectric interval and S-V6 RWPT, is more prevalent in patients with native right bundle branch block. The isoelectric interval and current of injury (COI) are critical for guiding lead implantation during continuous monitoring-guided SLBBP.
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