Arrhythmias & electrophysiology
Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing
Authors' conclusion
Interobserver agreement and correlation with intraprocedural confirmation (gold standard) are only moderate, whereas intraobserver agreement on ECG-based differentiation of capture type and septal lead location is substantial. Vectorcardiographic QRS-area slightly outperforms clinical judgment in distinguishing capture types and may be a useful objective alternative.
Study context
- Population
- Patients with baseline narrow QRS undergoing left bundle branch area pacing (LBBAP) implantation
- Participants
- 50 patients100 electrocardiogram (ECGs)
- Comparison
- Clinical ECG judgment vs vectorcardiographic QRS-area vs intraprocedural confirmation of left bundle branch (LBB) capture and septal lead position
- Outcome
- Inter- and intraobserver agreement and accuracy of clinical ECG judgment for LBB-capture and septal lead position
Methodological detailsblinded observers
- Blinded observers
Performance
As reported in the abstract
| Test or model | Interobserver agreement, capture type (Light's kappa) | Intraobserver agreement, capture type (Light's kappa) | Concordance with intraprocedural confirmation | Interobserver agreement, septal position (Light's kappa) | Intraobserver agreement, septal position (Light's kappa) |
|---|---|---|---|---|---|
| Clinical judgment | 0.43 | 0.62 | 72% | 0.43 | 0.77 |
Clinical judgment
Interobserver agreement, capture type (Light's kappa)0.43
Intraobserver agreement, capture type (Light's kappa)0.62
Concordance with intraprocedural confirmation72%
Interobserver agreement, septal position (Light's kappa)0.43
Intraobserver agreement, septal position (Light's kappa)0.77
Further findings
Distinguishing LVSP from nsLBBP
Cutoff QRS-area 26 mV.ms
Accuracy
Distinguishing left ventricular septal pacing (LVSP) from nsLBBP
- QRS-area significantly higher for LVSP than nsLBBP; QRS duration not
Original publication
Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing. Heart Rhythm. Published 17 March 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →