A MacGyvering way to left bundle branch area pacing: Using the modified V1/V6 leads connected to the pacing system...

There is a significant impediment to the availability of a fully capable electrophysiology (EP) procedure room and EP recording system due to healthcare cost restraints in resource-poor settings.

The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test machine 12-lead ECG system and modified V1 and V6 leads connected to the pacing system analyzer (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP).

LBBaP was attempted by a single operator using the Medtronic 3830 lumenless leads and St. Jude/Abbott stylet-driven leads in a mixed cohort of patients at hospitals lacking an EP recording system. Conduction system capture was assessed using modified V1 and V6 leads.

LBBaP was successful in 18 (94.7%) of 19 patients. There was excellent correlation between 12-lead ECG and modified V1 and V6 leads connected to the PSA regarding the measurement of V6 left ventricular activation time and QRS morphology change in V1 during selective to nonselective left bundle branch capture. Patient characteristics were the following: mean age of 66.7 ± 11.47 years, 52.63% male, 10.52% with ischemic cardiomyopathy, and 5.26% with nonischemic cardiomyopathy. LBBaP resulted in a QRS duration of 112.77 ±11.27 ms with a left ventricular activation time of 70.55 ± 8.02 ms. Left ventricular ejection fraction improved in the patients with cardiomyopathy from 33.4 ± 5.77% to 48.2 ± 12.37% (P = .028).

The modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful LLBaP.