My preferred approach to left bundle branch area pacing: Stylet-driven leads

Figure 1. A: Deep septal lead deployment in a patient with hypertrophic septum. The stylet-driven pacing lead (SoliaS 60; Biotronik) needed an implant depth of 15–16 mm to achieve left bundle branch pacing. Contrast injections are not essential, although they can help to assess lead depth and exclude complications such as septal coronary artery fistulas. B: The stylet of standard stylet-driven pacing leads adds support to the lead, which facilitates to keep stable positions and track on the septum, even in case the delivery sheath reverses due to the pushing forces on the septum. C: Continuous monitoring of unipolar pacing characteristics during deep septal lead deployment can easily be achieved by connecting the crocodile clamps to the stylet of the pacing lead, rather than the lead pin. This way, lead rotations do not become hampered by the jump cable getting twisted around the pacing lead.