Left Bundle Branch Pacing Guided by Premature Ventricular Complexes
During Implant
Abstract
Left bundle branch pacing (LBBP) provides synchronized contraction of
ventricles and overcomes the limitation of His bundle pacing (HBP). The
pacing lead is placed deep inside the septum 1-1.5 cm apical to the
distal His bundle region. The criteria for capture of left bundle branch
(LBB) have been proposed but it has never been validated. LBB potentials
may not be demonstrable in all patients. Premature ventricular complexes
(PVC) are often noted while positioning the lead in the interventricular
septum. The morphology of the PVCs depends on the depth of the lead in
the septum. We describe a novel method for lead placement to capture LBB
by monitoring the morphology and duration of PVCs in four patients with
different pacing indications. Rapid rotations were stopped immediately
on observing a PVC with narrow QRS duration and qR (right bundle branch
delay) pattern in lead V1. LBB potential and non-selective to selective
LBB capture could be demonstrated after placing the lead. PVC guided
lead placement would help in final positioning of the lead, avoid
perforation into left ventricle cavity and to confirm conduction system
capture.