Key result
Continuous pacing during LBBP allows real-time monitoring to confirm capture and avoid septal perforation.
Why the study?
Intermittent pacing during left bundle branch pacing cannot monitor current of injury changes in real time, missing information about the entire process during lead implantation.
Case Report (n=1)
No
Continuous real-time monitoring of current of injury and QRS morphology during left bundle branch pacing can help confirm capture and prevent septal perforation.
May aid real-time capture confirmation and perforation avoidance during left bundle branch pacing; hypothesis-generating and requires prospective validation.
Background: Left bundle branch (LBB) pacing (LBBP) has recently emerged as a physiological pacing mode. Current of injury (COI) can be used as the basis for electrode fixation position and detection of perforation. However, because the intermittent pacing method cannot monitor the changes in COI in real time, it cannot obtain information about the entire COI change process during implantation. Case summary: Left bundle branch pacing was achieved for treatment of atrioventricular block in a 76-year-old female. Uninterrupted electrocardiogram and electrogram were recorded on an electrophysiology system. In contrast to the interrupted pacing method, this continuous pacing and recording technique enables real-time monitoring of the change in ventricular COI and the paced QRS complex as the lead advances into the interventricular septum. During the entire screw-in process, the COI amplitude increased and then decreased gradually after reaching the peak, followed by a small but significant, rather than dramatic, decrease. Conclusion: This case report aims to demonstrate the clinical significance of changes in COI and QRS morphology for LBBP using real-time electrocardiographic monitoring and filtered and unfiltered electrograms when the lead is deployed using a continuous pacing technique. The technique could be used to confirm LBB capture and avoid perforation.
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Shen et al. (2022) conducted a case report in Atrial fibrillation and third-degree atrioventricular block (n=1). Left bundle branch pacing with continuous pacing and recording technique was evaluated on Real-time monitoring of current of injury and QRS morphology. Continuous pacing and recording during left bundle branch pacing enabled real-time monitoring of current of injury and QRS morphology to confirm capture and avoid septal perforation.
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