Electrophysiological Insights into Three Modalities of Left Bundle Branch Area Pacing in Patients Indicated for Pacing Therapy

Clinical impact of left bundle branch area pacing in heart failure with preserved ejection fraction and mid‐range ejection fraction

“…Zhang et al. demonstrated no evidence of selective and nonselective LBB capture during screwing of the pacing lead, which they defined as DSP 22 . Furthermore, they speculated whether the impact of DSP on clinical outcomes would be similar to that of LBBP given that LVAT in DSP was only slightly longer than that in LBBP.…”

“…As repeated in previous studies, LBBAP can be divided into two different pacing modalities based on whether or not the left bundle branch (LBB) is captured 21,22 . LBBP was defined as LBB capture, which was confirmed when all of the following criteria were satisfied: (1) paced‐QRS morphology of the right bundle branch block during unipolar pacing; (2) short (< 80 ms) and stable LVAT at high and low output pacing measured from the onset of the pacing spike to the peak of the R wave in the V5–V6 leads; and (3) evidence of direct LBB capture, such as reversal His potential, orthodromic capture of distal LBB, or presence of LBB potential.…”

“…LBB capture during screwing of the pacing lead, which they defined as DSP. 22 Furthermore, they speculated whether the impact of DSP on clinical outcomes would be similar to that of LBBP given that LVAT in DSP was only slightly longer than that in LBBP. Hayashi et al demonstrated that the shorter paced-QRS duration in LBBP compared to that in RVSP can be mainly explained by the passing over of the transseptal conduction.…”

Anatomical and histological assessment of left bundle branch area pacing in human heart with refractory heart failure

“…Recent studies have proposed the concept of LBBAP or deep septal pacing (DSP), 5,8,10 which may have longer LVAT and wider QRS duration than LBBP. LBBP is defined as pacing the proximal LBB or its branches with or without capture of LV septal myocardium.…”

“…[4][5][6] Most studies have shown that operators used imaging technique and electrical parameters to locate the position and depth of the pacing lead model 3830 and to make sure the stability of the lead parameters through follow-up. 3,7,8 For example, sheath angiography or nine-partition method 9 was utilized to determine the initial lead tip location and test the pacing impedance, and capture threshold was used to check if there was a lead perforation. For patients with significantly enlarged heart in particular, achieving an ideal position of the pacing lead in the septum remains a challenge.…”