A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Left bundle branch (LBB) pacing is an emerging technique for cardiac pacing.
• Standardized fluoroscopic methods for LBB pacing lead placement are lacking.

Purpose of the Study:

• To analyze the imaging characteristics of His bundle (HB) and LBB pacing lead positions.
• To develop a fluoroscopic-guided method for optimal LBB pacing lead implantation.

Main Methods:

• Seventy patients undergoing HB or LBB pacing were analyzed.
• A 9-partition method was developed based on fluoroscopic ventricular contraction rings.
• Postoperative CT scans confirmed lead positions and measured distances to aortic cusps.

Main Results:

• LBB pacing leads were predominantly located in the junctional area of partitions 2 and 5.
• The 9-partition method improved LBB pacing success rates from 58.3% to 83.3% in prospective cases.
• Fluoroscopy time and screw site numbers were significantly reduced.

Conclusions:

• Distinct imaging patterns differentiate HB and LBB pacing lead locations.
• The proposed 9-partition method is effective for guiding successful LBB pacing lead placement.