Approach to Left Bundle Branch Pacing

Abstract

Cardiac pacing refers to the implantation tool serving as a treatment modality for various indications, the most common of which is symptomatic bradyarrhythmia. Left bundle branch pacing has been noted in the literature to be safer than biventricular pacing or His-bundle pacing in patients with left bundle branch block (LBBB) and heart failure, thereby becoming the focus of further research on cardiac pacing. A review of the literature was conducted using a combination of keywords, including "Left Bundle Branch Block," "Procedural techniques," "Left Bundle Capture," and "Complications." The following factors have been investigated as key criteria for direct capture: paced QRS morphology, peak left ventricular activation time, left bundle potential, nonselective and selective left bundle capture, and programmed deep septal stimulation protocol. In addition, complications of LBBP, inclusive of septal perforation, thromboembolism, right bundle branch injury, septal artery injury, lead dislodgement, lead fracture, and lead extraction, have also been elaborated on. Despite clinical implications based on clinical research comparing the use of LBBP with other forms such as right ventricular apex pacing, His-bundle pacing, biventricular pacing, and left ventricular septal pacing, a paucity in the literature on long-term effects and efficacy has been noted. LBBP can thus be considered to have a promising future in patients requiring cardiac pacing, assuming that additional research on clinical outcomes and the limitation of significant complications such as thromboembolism can be established.

Case report: Torsade de pointes induced by the bigeminy result from retrograde ventriculoatrial activation in VVI pacing and resolved by intentional atrial pacing

“…Traditional right ventricular pacing, as shown in our case, should be minimized. The novel conduction system pacing (CSP) would be a promising modality for physiological ventricular activation in patients who need ventricular pacing ( 13 , 14 ), although the sole adoption of CSP would not solve VA retrograde conduction. For our patient with sinus node dysfunction instead of atrioventricular block (AVB), dual-chamber ICD with minimized ventricular pacing algorism by using defibrillation RV lead implanted on the septum would be an optimal choice.…”