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Left Bundle Branch Pacing Guided by Premature Ventricular Complexes During Implant
  • Shunmuga Sundaram,
  • Pugazhendhi Vijayaraman
Shunmuga Sundaram
Velammal Medical College Hospital and Research Institute
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Pugazhendhi Vijayaraman
Geisinger Heart institute
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Abstract

Left bundle branch pacing (LBBP) provides synchronized contraction of ventricles and overcomes the limitation of His bundle pacing (HBP). The pacing lead is placed deep inside the septum 1-1.5 cm apical to the distal His bundle region. The criteria for capture of left bundle branch (LBB) have been proposed but it has never been validated. LBB potentials may not be demonstrable in all patients. Premature ventricular complexes (PVC) are often noted while positioning the lead in the interventricular septum. The morphology of the PVCs depends on the depth of the lead in the septum. We describe a novel method for lead placement to capture LBB by monitoring the morphology and duration of PVCs in four patients with different pacing indications. Rapid rotations were stopped immediately on observing a PVC with narrow QRS duration and qR (right bundle branch delay) pattern in lead V1. LBB potential and non-selective to selective LBB capture could be demonstrated after placing the lead. PVC guided lead placement would help in final positioning of the lead, avoid perforation into left ventricle cavity and to confirm conduction system capture.