Left Bundle Branch Pacing Facilitated by Novel Surface Electrocardiography in Comparison with Electrophysiology Recording System

Introduction: Left bundle branch pacing (LBBP) had been proven to be feasible and safe in patients with pacing indication. In this study, we assessed the feasibility and safety of LBBP procedure using simplified ECG monitoring and LBBP criteria in comparison with that by using the conventional electrophysiology recording system (EP recording system) and currently adopted LBBP criteria. Methods: The single-center study included 143 consecutive patients from March 2021 to January 2022. The operator was single-blinded to the EP recording system, where they were only avail of a four-lead ECG monitor to observe the morphological changes of pacing QRS and the pacing system analyzer (PSA) to record the intracardiac EGM. Other researchers kept synchronized records of the EP recording system, and analyzed whether the data collected were consistent with LBBP, which was blinded to the implanting operator. Intraoperative data were collected and the safety of follow-up were evaluated. Results: Of 143 patients enrolled, 139 successfully performed LBBP with a success rate of 97.2%, with a perceived clinical judgement consistent with LBBP on the four-lead ECG monitor in concordance with EP recording system at 99.3%. The fluoroscopy time of left bundle branch (LBB) lead deployment had no significant difference with previous studies. Ventricular septal perforation occurred in 2 patients during the procedure. Pacing parameters were stable and heart function improved during follow-up. Conclusion: LBBP implantation approach simply relying on a four-lead ECG system without an EP recording system combined with an analyzer is feasible and safe.