Heterogeneity in clinical judgment for confirming septal lead position and capture type in left bundle branch area pacing
Notice bibliographique
Résumé
Abstract Background Determining lead location and confirming conduction system capture during left bundle branch area pacing (LBBAP) relies on criteria which are primarily obtained during implantation. However, the extent to which clinical judgment of the post-implant ECG varies among implanting cardiologists is unclear. Purpose To investigate inter- and intra-observer agreement in clinical judgment of the post-implant ECG in determining lead position and conduction system capture in patients undergoing LBBAP implantation. Methods Unipolar paced ECGs during LBBAP implantation from 50 patients with preserved ejection fraction and baseline narrow QRS were collected. Conduction system capture was attempted in all patients and assessed using QRS morphology transitions during threshold testing following the EHRA 2023 consensus statement (gold standard). Eight experienced LBBAP-implanting cardiologists from six tertiary referral centers were asked to classify 100 ECGs, consisting of 50 unique ECGs presented twice to assess intra-observer variability. The classification included capture types (non-selective, left ventricular septal, deep septal, and right ventricular capture) and septal location (proximal left bundle, anterior-, posterior-, or septal fascicular). To assess both inter- and intra-observer variability, Cohen’s kappa statistics were employed for all possible pairs to provide a single index (Light’s kappa). Results The inter-observer variability ranged from 0.255 to 0.753 (averaged Light’s kappa of 0.456 and 0.402 for the first and second ECG respectively), indicating a moderate agreement. The mean absolute inter-observer agreement for capture type was 0.689 (95% CI: 0.562 – 0.816). The intra-observer agreement for capture type was substantial, ranging from 0.398 to 0.801 (averaged Light’s kappa 0.619). There was a 72% (58-85%) concordance between clinical judgement and intra-procedural confirmation of capture type. There was moderate agreement with regards to lead location along the septum with an inter-observer agreement of 0.130 to 0.751 (averaged Light’s kappa 0.416 for the first assessment and 0.434 for the second) and an intra-observer agreement of 0.623 to 0.848 (averaged Light’s kappa 0.765) .As for capture type, the intra-observer agreement was substantial. The mean absolute inter-observer agreement for septal location was 0.568 (95% CI: 0.431 – 0.705). Conclusion The post LBBAP-implant ECG evaluation demonstrated substantial intra-observer agreement but only moderate inter-observer agreement and moderate correlation with the intra-procedural capture results in assessing capture type. As for determination of septal lead location, intra-observer and inter-observer agreement were substantial and moderate respectively. Differentiating capture types and septal lead location on ECG appears highly subjective between and within observers, highlighting the need for standardized or quantitative ECG assessment.Capture type Septal location
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».