Impact of Different Pacing Sites on Pre‐Implantation Screening Test of Subcutaneous Implantable Cardioverter Defibrillators

作者：Youmei Shen, Weizhu Ju, Hongwu Chen, Hailei Liu, Linlin Wang, Xiaohong Jiang, Gang Yang, Mingfang Li, Kai Gu, Minglong Chen · 发表于：Journal of Cardiovascular Electrophysiology · 年份：2025 · DOI：10.1111/jce.70216 · 被引用次数：1 · 研究领域：Cardiac pacing and defibrillation studies、Cardiac Imaging and Diagnostics、Cardiac Arrhythmias and Treatments

BACKGROUND: Pre-implantation screening is a crucial step in preventing inappropriate sensing in patients with subcutaneous implantable cardioverter defibrillators (S-ICDs). Paced QRS-T morphology may influence screening outcomes. We aimed to explore the impact of pacing rhythm and different pacing sites on pre-implantation screening of S-ICD. METHODS AND RESULTS: This prospective, single-center study enrolled patients referred for radiofrequency ablation, with both left and right-heart access. A contact-force ablation catheter was used to mimic ventricular pacing at different sites. Automatic screening tests for S-ICD eligibility were performed during pacing and sinus rhythm. The impact of pacing sites on S-ICD eligibility was assessed. Thirty patients (age 54.0 ± 15.0 years, 73.3% male) were enrolled. The overall passing rate during intrinsic sinus rhythm was 86.7%. Compared with sinus rhythm, conduction system pacing from His bundle or left bundle branch demonstrated comparable pass rates and the number of passed vectors, whereas right ventricular septum (RVS) pacing exhibited significantly lower pass rates and less pass vectors. Among all RVS pacing sites, the lowest pass rate was observed at the apical portion, followed by middle and basal portion (p < 0.001 for all comparisons). CONCLUSION: Conduction system pacing preserves patient eligibility for S-ICD comparable to sinus rhythm, while RVS pacing significantly impairs sensing performance, with the greatest deterioratio...