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Left bundle branch pacing is a physiological pacing modality with a low and stable threshold. The electrophysiological characteristics and mechanisms of bipolar pacing remain unclear.This study aimed to assess the electrophysiological characteristics of bipolar pacing of left bundle branch pacing and to infer the mechanisms underlying each electrocardiogram and electrogram waveform morphology.A total of 65 patients who strictly met the criteria for left bundle branch capture were enrolled. The changes in the morphology of the electrocardiogram and electrogram during the threshold testing with different outputs on unipolar and bipolar pacing were recorded. The electrophysiological characteristics were then analyzed.Four distinct morphologies and 3 different types of transitions during bipolar pacing threshold testing were identified; we labeled the 4 types of morphologies as nonselective (NS)-bipolar-left bundle (LB), NS-cathodal-LB, selective (S)-cathodal-LB, and left ventricular septal-cathodal. Except left ventricular septal-cathodal, the other 3 types (NS-bipolar-LB, NS-cathodal-LB, and S-cathodal-L) had a short and constant VWith a higher output on bipolar pacing, NS-bipolar-LB capture had the shortest V

Although the interest in conduction system pacing is increasing, the data on longitudinal dissociation in the literature is still limited. METHODS AND RESULTS: We performed left bundle branch (LBB) pacing on a patient with sick sinus syndrome and atrioventricular block. The transition of QRS morphology can be observed during the threshold testing. The main findings were different left ventricular activation times when selective LBB capture was performed at different outputs.This phenomenon may be due to the anatomical basis of longitudinal dissociation of the His-Purkinje system, which allows pacing stimulation at different thresholds to excite different portions of the conduction system.

The present study aimed to evaluate the feasibility and safety of the novel left bundle branch pacing (LBBP) procedure that uses isoelectric interval as an endpoint for lead implantation.A total of 41 patients with indications for pacing were enrolled. All patients underwent a novel LBBP procedure guided by recording an isoelectric interval as an endpoint for lead implantation. The procedural details and electrophysiological characteristics were then analyzed.A total of 38/41 (92.7%) cases were confirmed of left bundle branch (LBB) capture. An isoelectric interval was observed in 36/41 cases (87.8%). A total of 36/41 (87.8%) cases with LBB potential were observed. The mean unipolar LBBP threshold at the implant was 0.5 ± 0.2 V. The mean sensed amplitude of the R wave and the pacing impedance at the implant were 12.9 ± 5.0 mV and 723.5 ± 117.1 Ω. During the final threshold testing, a transition from non-selective to selective LBBP (S-LBBP) was demonstrated in 26 patients. A transition from non-selective LBBP (NS-LBBP) to left ventricular septal myocardial capture was observed in 12 patients.Using an isoelectric interval as an endpoint to guide the LBBP was feasible in a high proportion of captured LBB cases.

It was shown that V6 R-wave peak time (V6 RWPT) prolongs with transition form non-selective left bundle branch pacing (ns-LBBP) to left ventricular septal pacing (LVSP) but remains constant or slightly prolongs with transition to selective left bundle branch pacing (sel-LBBP) [1,2]. Here, we report on a patient who was observed with a LBB potential, isoelectric interval, where the V6 RWPT substantially prolonged with transition from ns-LBBP to sel-LBBP at near threshold output.

Left bundle branch pacing (LBBP) is considered as an innovative physiologic pacing form because of lower thresholds compared with His bundle pacing and can partially resolve distal bundle disease (1). Our group had reported a novel LBBP lead implantation procedure guided by electrocardiogram (ECG) and electrogram (EGM) morphology under beat-to-beat monitoring, and found the isoelectric interval was a safe and precise endpoint for implantation, and was feasible in 87.8% (2). Few studies described the ECG and EGM characteristics of bipolar pacing due to the inaccuracy of selective left bundle branch pacing (SLBBP). This is the first case to report the electrophysiological characteristics of four unipolar or bipolar pacing modes and try to analyze the potential mechanism of different ECG and EGM morphology.

Left bundle branch area pacing (LBBAP) is a physiological pacing method for treatment of atrioventricular block. However, there is a need for a new convenient and safe method for performing left bundle branch pacing (LBBP) and to confirm left conduction system capture.This study aimed to explore a new convenient and safe method for performing selective LBBP.A total of 28 patients who had indications for pacing therapy and received LBBAP were recruited retrospectively. Demographic and baseline patient characteristics, electrocardiograms, pacing parameters, and intracardiac electrogram pattern were evaluated. Continuous unipolar pacing at low output (2 V / 0.5 ms) was performed during the whole period of LBBP lead implantation. Successful left bundle branch (LBB) capture was defined as the abrupt change of the pacing stimulus to the peak of R wave in lead VThe parameters of the 2 shortenings (stimulus-to-peak left ventricular activation time [S-peak LVAT] before shortening, S-peak LVAT after shortening, and the duration of shortening) all showed a significant positive correlation (Pearson product-moment correlation coefficient [PCC] = 0.915,Abrupt shortening of the S-peak LVAT at continuous low output was associated with abrupt shortening of the S-peak LVAT at low and high output. High rate of selective LBB capture can be achieved with the method of continuous low output, shortening the S-peak LVAT.

ObjectiveThe characteristics of discrete intracardiac electrograms in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete ventricular components in an intracardiac electrogram (EGM) and to analyze its possible mechanisms.MethodsThis study included 95 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings (30, 60, 100, and 200 Hz) with a low-pass filter at 500 Hz, and their possible mechanisms were analyzed.ResultsLBBP was successfully achieved in 92.6% (88/95) of patients. SLBBP was achieved in 80 patients. The occurrence rates of discrete EGM were 18.9%, 40.0%, 74.7%, and 84.2% for HPF settings of 30 Hz, 60 Hz, 100 Hz, and 200 Hz, respectively. The analysis of discrete ECG detection showed significant differences between the different HPF settings. By using the discrete EGM as the SLBB capture golden standard, the results of EGMs revealed that the 30 Hz HPF has a sensitivity of 23% and specificity of 100%. The 60 Hz HPF had a sensitivity of 48% and a specificity of 100%. The 100 Hz HPF had a sensitivity of 89% and a specificity of 100%. The 200 Hz HPF had a sensitivity of 100% and specificity of 100%.ConclusionsAn optimal HPF setting of 200 Hz is recommended for discrete electrogram detection. A discrete EGM should exhibit an isoelectric interval. A steep deflection and spinous ventricular EGM morphology nearly identify an intrinsic EGM morphology.

A 75-year-old man with atrial fibrillation and III atrioventricular block (AVB) with a slow escape rhythm and right bundle branch block (RBBB) underwent His-bundle pacing (HBP). The procedure was guided by the tricuspid valve annulus (TVA) visualisation technical without His-bundle (HB) potentials recorded and got a low HB capture threshold. The transition from non-selective (NS) -HBP to selective (S) -HBP can be seen during the threshold test. It is possible to achieve HBP without HB potentials recorded in the whole procedure.

BACKGROUND AND PURPOSE Sleep disturbance and cognitive impairment are common and related in the elderly population worldwide. The aim of the present study was to explore the association between sleep disturbance and motoric cognitive risk (MCR) syndrome, which is characterized by subjective cognitive complaints and objective slow gait in older individuals without dementia or any mobility disability in the community-dwelling elderly Chinese population. METHODS We recruited 940 participants aged ≥65 years from November 2016 to March 2017 in the Ningbo Community Study on Aging (NCSA). Self-reported sleep duration and sleep-quality variables, comprehensive geriatric evaluation, as well as indicators for diagnosing MCR syndrome were evaluated in this cross-sectional study. RESULTS Multiple logistic regression analysis showed that a 1-SD increase in night (1.1 h) and 24-h sleep duration (1.3 h) was associated, respectively, with a 21% (95% confidence interval [CI], 1%-47%; p = 0.04) and 30% (95% CI, 3%-64%; p = 0.03) higher odds of having MCR syndrome. Considering sleep duration as a categorical variable, longer night-sleep duration (>8.5 h) was associated with MCR syndrome (OR, 2.03; p = 0.02) compared to shorter night-sleep duration (

Left bundle branch pacing (LBBP) is a promising approach for achieving near-physiologic pacing. However, differentiating LBBP from left ventricular septal endocardial pacing (LVS(e)P) remains a challenge. This study aimed to establish a simple and effective method for differentiating LBBP from LVS(e)P and to evaluate their electrophysiologic characteristics.LBBP, using continuous uninterrupted pacing and real-time monitoring of electrocardiograms along with intracardiac electrograms, was performed in 97 consecutive patients. We evaluated the electrophysiologic characteristics observed during LBBP using 6 modalities: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP 1 and 2), LVS(e)P, nonselective LBBP (NSLBBP), and selective LBBP (SLBBP).Of the 97 patients, 87 (89.7%) met the criteria (abrupt change in paced QRS morphology with a transition from Qr to QR/qR in lead V1 and shortening of stimulus to V6 R-wave peak time [Stim-V6RWPT] of ≥ 10 ms with constant output while rather than after lead screwing) for nonselective left bundle branch (LBB) capture. Selective LBB capture was observed in 82 patients (84.5%). The Stim-V6RWPT of NSLBBP and SLBBP were significantly shorter than LVS(e)P (respectively, 67.1 ± 8.7 ms, 67.0 ± 9.3 ms, and 82.1 ± 10.9 ms). Stim-QRSend was the narrowest in IVSP2 (136.6 ± 15.2 ms) instead of NSLBBP (140.0 ± 17.1 ms).The uninterrupted pacing technique for differentiating LBBP from LVS(e)P in the same group of patients is feasible. Electrophysiologic evidence from our intrapatient-controlled study shows that LBBP and LVS(e)P differ in ventricular electrical synchronization.

Aims/Introduction Although increased reactive oxygen species (ROS) generation is a major mechanism leading to cardiac remodeling in diabetes mellitus, research into the effects of anti‐oxidation on diabetic cardiac remodeling remains scarce and controversial. Glucagon‐like peptide‐1 (GLP‐1) shows potential anti‐oxidative effects besides lowering blood glucose. The objective of this research was to investigate the effects of GLP‐1 on cardiac remodeling and the molecular mechanism involved in diabetes mellitus. Materials and Methods Streptozotocin‐induced diabetic rats received exenatide treatment for 3 months. Cardiac function, cardiac weight index and myocardial interstitial fibrosis were measured. Cardiomyocytes were cultured in high‐glucose medium with GLP‐1 treatment. The ROS production, apoptosis and the levels of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase protein expression in cardiomyocytes were analyzed. Results Experimental diabetes mellitus showed impaired cardiac diastolic function, increased brain natriuretic peptide expression and increased interstitial collagen deposition in the myocardium, which were ameliorated by exenatide treatment. Exenatide reduced myocardial ROS production and apoptosis in diabetes mellitus. Also, high glucose‐induced ROS generation and apoptosis in cardiomyocytes were inhibited by GLP‐1, as well as the levels of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase phosphorylation. Furthermore, GLP‐1 treatment upregulated adenosine monophosphate‐activated protein kinase activity in high‐glucose‐induced cardiomyocyte. Conclusions Glucagon‐like peptide‐1 protects the cardiomyocytes from oxidative stress and apoptosis in diabetes mellitus, which might contribute to the improvement of cardiac remodeling. The cardiac protection of GLP‐1 might be dependent on inhibition of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase, through an adenosine monophosphate‐activated protein kinase‐mediated pathway., Glucagon‐like peptide‐1 protects cardiomyocytes against oxidative stress, apoptosis and the resultant myocardial fibrosis in diabetes mellitus, which might contribute to the improvement of cardiac remodeling. The protective effects of glucagon‐like peptide‐1 are dependent on downstream inhibition of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase, through an adenosine monophosphate‐activated protein kinase‐mediated pathway.

Transcatheter aortic valve replacement (TAVR) is a revolutionized treatment for severe aortic valve stenosis. Although new and improved TAVR devices are constantly being developed, cardiac conduction abnormalities post-TAVR requiring permanent pacemaker implantation (PPMI) still occur frequently. Previously, pre-existing right bundle branch block (RBBB) has been shown to be predictive of PPMI after TAVR, while occurrence of new left bundle branch block (LBBB) was associated with a higher rate of PPMI. However, less attention has been paid to the clinical values of new-onset RBBB post-TAVR. To our knowledge, this is the first report focus on the association of new-onset RBBB and PPMI after TAVR. Sometimes only changes in the right bundle branch can be detected, but the patient may have co-existing severe conduction block at this time, which caused adverse events including Adams-Stokes syndrome. New-onset RBBB post-TAVR may also have important clinical implications.

It was recently shown that template beats and fixation beats of the premature ventricular contractions (PVCs) were generated during lead deployment. These could be exploited to guide the left bundle branch (LBB) pacing (LBBP) procedure. However, lack of a revolving connector that can continuously record and pace during lead rotations has been a limitation when using the traditional implant technique. Here, we report ten cases in which a revolving connector was used and showed that the premature beats of selective left bundle branch (SLBB-PBs) were generated as the lead was reached and the electrical stimulus selectively captured the LBB.Ten patients who underwent the transseptal placement of the pacing lead using a revolving connector were included in the study. We aimed to examine whether the SLBB-PB was a marker of LBB capture during LBBP and the clinical significance of SLBB-PB. LBBP was performed and data of these cases were analyzed to show the characteristics of the electrocardiogram and the intracardiac electrogram of SLBB-PBs.This is the first case series on SLBB-PBs in LBBP. The presence of SLBB-PBs suggested that the LBB was reached and selectively captured and possibly increased the safety of lead implantation.

Transcatheter aortic valve replacement (TAVR) is a revolutionized treatment for severe aortic valve stenosis. Although new and improved TAVR devices are constantly being developed, cardiac conduction abnormalities post-TAVR requiring permanent pacemaker implantation (PPMI) still occur frequently1. Previously, pre-existing right bundle branch block (RBBB) has been shown to be predictive of PPMI after TAVR compared with patients without RBBB2, while occurrence of new left bundle branch block (LBBB) was associated with a higher rate of PPMI3. However, less attention has been paid to the clinical values of new onset non-LBBB conduction disturbances such as RBBB, left anterior fascicular block (LAFB) or atrioventricular block (AVB). To our knowledge, this is the first report focus on the association of new-onset non-LBBB and PPMI after TAVR. The study was approved by the Ethics Committee of HwaMei Hospital, University of Chinese Academy of Sciences. This article is protected by copyright. All rights reserved.

BACKGROUND AND PURPOSE A recently proposed pre-dementia syndrome, motoric cognitive risk (MCR) syndrome, is characterized by cognitive complaints and slow gait, and increases the risk of dementia and mortality. The aim of the present study was to explore the prevalence of and factors associated with MCR syndrome in elderly community-dwelling Chinese subjects. METHODS The Ningbo Community Study on Aging recruited 953 Chinese community-dwelling participants aged ≥ 65 years from November 2016 to March 2017. Handgrip, Five-Times-Sit-to-Stand (FTSS) test time and body composition, as well as comprehensive geriatric evaluation, were measured as potentially independent factors associated with MCR syndrome. RESULTS The prevalence of MCR syndrome was 12.8% in men and 12.6% in women, and high prevalence of MCR syndrome was not associated with age or sex. Multiple logistic regression analysis by sex showed that a 1-SD increase in FTSS test time in males and females was associated with 45% (95% confidence intervals, 19-76; P