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Related Experiment Video

Updated: Aug 27, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Left bundle area pacing: Guiding implant depth by ring measurements.

Michael V Orlov¹, Marianna Nikolaychuk¹, Ioannis Koulouridis¹

¹Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts.

|September 24, 2022

Summary

Ring pacing parameters offer better insights into lead placement success during left bundle area pacing (LBAP) than tip measurements. These findings may help optimize lead depth and reduce the need for contrast imaging.

Keywords:

Depth of lead implantation Lead-septal angle Left bundle area pacing Unipolar ring impedance Unipolar ring measurements Unipolar ring pacing threshold

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Area of Science:

Cardiology
Electrophysiology
Medical Device Technology

Background:

Current criteria for successful left bundle area pacing (LBAP) rely on lead tip measurements and are not well-established.
Lead ring measurements during LBAP have not been extensively studied for predicting implant success.

Purpose of the Study:

To investigate the dynamics of pacing parameters during both successful and unsuccessful lead implant attempts for LBAP.
To determine if lead ring measurements can predict lead depth and implant success.

Main Methods:

Retrospective review of procedural, echocardiographic, and pacing data from 73 patients undergoing LBAP with SelectSecure 3830 leads.
Analysis of lead depth and lead-septal angle using fluoroscopy and septal contrast.
Correlation of pacing parameters (tip and ring impedance, unipolar ring threshold) with lead depth and implant success.

Main Results:

Ring impedance increased significantly during successful LBAP attempts compared to unsuccessful ones (P = .039).
Higher ring impedance correlated with a wider lead-septal angle (P = .036), while tip impedance showed no such association.
Unipolar ring threshold correlated with lead implant depth (P = .029), unlike tip impedance measurements.

Conclusions:

Lead ring pacing parameters are more predictive of lead progress and depth during LBAP than traditional tip measurements.
Ring impedance measurements can potentially determine lead depth and lead-septal angle, possibly eliminating the need for contrast injection.