Premature beat of selective left bundle branch: a novel marker for reaching and capturing the left bundle branch

Right subclavian vein approach for selective left bundle branch pacing: A case report

“…During the screwring procedure, the tail of pacing lead was always connected with the John Jiang's connecting cable. The recent research by our team has showed that the equipment might be more effective and convenient to monitor ECG, EGM, and impedance in real time to avoid perforation and to guide effective endpoint without the need to stop pacing (Shen, Jiang, Cai, et al, 2022; Shen, Jiang, Jiang, et al, 2022; Wu et al, 2022), so when the vascular pathway was established, TVA angiography was performed, and sheath was placed in what we thought the ideal position, the screwing of lead started. During the process, a narrow premature beat which shows right bundle branch conduction delay (RBBD) with an rSR pattern in V1 occurred (Figure 2).…”

“…Usually, premature beat often occurred during the lead screwing from right ventricular septum (VS) to left VS. Recently, we have reported that premature beat of selective left bundle branch (SLBB‐PB) may be a novel marker for reaching and capturing the left bundle branch (Shen, Jiang, Cai, et al, 2022; Shen, Jiang, Jiang, et al, 2022), so when the SLBB‐PB occurred, it means that the lead is closer to the conduction system. At this time, the lead screwing was stopped and the impedance was monitored frequently Immediately, an isoelectric interval on the ECG and an S‐V interval on the EGM were recorded (Figure 2).…”

“…After that, a right ventriculography in the right anterior oblique (RAO) 30° which can show the TVA was performed to ascertain the final position of LBBP (Figure 1b). The John Jiang's connecting cable that can monitor ECG and intracardiac EGM in real time from the pacing lead (Model 3830 69 cm; Medtronic Inc.) was connected to the electrophysiological multichannel recorder system (Shen, Jiang, Cai, et al, 2022; Shen, Jiang, Jiang, et al, 2022; Figure 1e). Compared with the traditional connecting cable, the John Jiang's connecting cable has an additional connecting channel.…”

High-pass filter settings and possible mechanism of discrete electrograms in left bundle branch pacing

“…LBBP uses the continuous pacing and recording technique, and the procedure has been described by us in detail elsewhere. [8][9][10] The study protocol was approved by the Ethics Committee of the Hwa Mei Hospital, Ningbo, China. Written informed consent was obtained from all patients.…”

Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography

“…In contrast to the interrupted pacing method, this continuous pacing and recording technique enables real-time monitoring of changes in ventricular COI and the paced QRS complex as the lead advances into the interventricular septum. We previously described the LBBP implantation procedure in detail ( 7 , 8 ). During the entire screw-in process, the COI amplitude increased, peaked, and gradually decreased, followed by a small but significant abrupt decrease ( Figure 1 ).…”