Guidance on left bundle branch pacing using continuous pacing technique and changes in lead V1 characteristics under real-time monitoring

Nan Zheng; Longfu Jiang; Jiabo Shen; Jinyan Zhong

doi:10.3389/fcvm.2023.1195509

Guidance on left bundle branch pacing using continuous pacing technique and changes in lead V1 characteristics under real-time monitoring

Front Cardiovasc Med. 2023 Sep 29:10:1195509. doi: 10.3389/fcvm.2023.1195509. eCollection 2023.

Authors

Nan Zheng¹, Longfu Jiang¹, Jiabo Shen¹, Jinyan Zhong¹

Affiliation

¹ Department of Cardiovascular Medicine, Ningbo NO.2 Hospital, Ningbo, China.

Abstract

Background: The changes in the morphology and characteristics of the V1 leads during left bundle branch capturing still need to be fully understood.

Objective: This study aims to provide some suggestions about the LBB capture process through the morphology and characteristics of the V1 lead.

Method: LBBP using the continuous pacing and morphology monitoring technique during screw-in using a revolving connector (John Jiang's connecting cable). The morphology and features of V1 leads are recorded by continuous monitoring technology.

Results: The most common morphology in the LVSP stage is QR, while in the NS-LBBP (low output) stage and the NS-LBBP (lower output) stage, it is rSR. In the S-LBBP stage, it is rsR. The predominant morphology is with r/R waves in S-LBBP, which includes variations like rSR, rsR, rSr, rsr, rR, rs, rS, and R type, making up 96.7% of the total. The r waves in lead V1 are associated with agitated myocardium conducted from the left bundle branch.

Conclusion: The initial r-wave in lead V1 may be a marker during the follow-up of patients with selective LBB capture.

Keywords: electrocardiogram; left bundle branch capture; left bundle branch pacing; left ventricular septal capture; physiological pacing.

Grants and funding

This work was supported by the Zhejiang Provincial Public Service and Application Research Foundation, China [grant number LGF22H020009], HwaMei Research Foundation of Ningbo No.2 Hospital [grant number 2023HMKY26], and the Ningbo Health Branding Subject Fund [grant number PPXK2018-01].