Left bundle branch pacing by standard stylet-driven lead: Preliminary experience of two case reports

Figures

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  Figure 1. A: The delivery catheter Selectra 3D (Biotronik SE & Co. KG, Berlin, Germany), with a double curve to allow septal positioning; note the standard screw lead exposed at the end of the delivery. B: The standard stylet-driven 6F lead inside the Selectra catheter. C: The standard stylet-driven 6F lead inside the Selectra catheter; note at the tip of the lead the fixation tool to screw the retractable helix.

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  Figure 2. Case 1. A: Baseline electrocardiogram (ECG) recording of native QRS, speed recording 50 mm/s. B: Final unipolar-paced ECG; note right bundle branch pattern in V1 compatible with QRS morphology of nonselective left bundle branch pacing, sweep speed 50 mm/s. C: Electrogram recorded in unipolar fashion from the tip of the lead in the final position showing left bundle (LB) potential (black arrow), sweep speed 100 mm/s. D: Left anterior oblique (LAO) fluoroscopic view after injection of small dose of contrast through the delivery catheter showing demarcation of right ventricular septum and the entire dipole lead penetrating the septum (zoomed in the small insert). E: Final LAO fluoroscopic view showing the LB lead and back-up lead.

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  Figure 3. Case 2. A: Left anterior oblique fluoroscopic view after injection of small dose of contrast through the delivery catheter showing demarcation of right ventricular septum and the entire dipole lead penetrating the septum. B: The fulcrum sign, a small angle between the final portion of the lead and the beginning of the dipole. C: Baseline electrocardiogram (ECG) recording of native QRS with right bundle branch block and left anterior fascicular block, ENDO depicted His electrogram (H), sweep speed 50 mm/s. D: His bundle pacing in unipolar fashion showing selective pacing without conduction disturbance correction, sweep speed 50 mm/s. E: Electrogram recorded in unipolar fashion from the tip of the lead in the final position showing left bundle potential (black arrow), sweep speed 50 mm/s. F: Final unipolar-paced ECG; note right bundle branch pattern in V1, compatible with QRS morphology of nonselective left bundle branch pacing, sweep speed 50 mm/s.