Key result
Multicomponent ventricular electrograms during LBBAP challenge the specificity of discrete potentials for selective capture.
Why the study?
The specificity of discrete electrograms for selective left bundle branch capture during left bundle branch area pacing is uncertain due to multicomponent local ventricular electrograms.
Case Report (n=1)
Selective left bundle branch capture should be confirmed through comprehensive unipolar threshold testing and systematic analysis rather than electrogram morphology alone.
A 63-year-old woman with sick sinus syndrome and recurrent syncope underwent left bundle branch area pacing lead implantation using a continuous pacing and recording technique. Multicomponent local ventricular electrograms were observed during left ventricular septal pacing, nonselective left bundle branch pacing, and selective left bundle branch pacing, challenging the specificity of discrete electrograms for selective capture. Potential mechanisms included overlapping potentials from distinct septal sources and far-field contributions. These findings suggested that selective left bundle branch capture should be confirmed through comprehensive unipolar threshold testing and systematic analysis of output-dependent electrophysiological transitions rather than electrogram morphology alone.
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Shen et al. (2026) conducted a case report in Sick sinus syndrome and recurrent syncope (n=1). Left bundle branch area pacing was evaluated on Electrogram characteristics during left ventricular septal and left bundle branch pacing. Left bundle branch area pacing resulted in multicomponent local ventricular electrograms, challenging the specificity of discrete electrograms for selective capture.
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