Innovative approach to conduction system pacing: Real-time ECG imaging guidance for precise left bundle branch area...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Left bundle branch area pacing (LBBAP) is a preferred method for cardiac pacing, offering physiological advantages over traditional right ventricular pacing.
• It is indicated for conditions like atrioventricular block, particularly in younger patients.

Purpose of the Study:

• To improve the accuracy of LBBAP lead placement.
• To develop and evaluate a novel implantation technique utilizing electrocardiographic imaging (ECGI).

Main Methods:

• A prospective, single-center study involving 10 patients undergoing LBBAP implantation.
• Real-time guidance and assessment using ECGI alongside traditional fluoroscopy and pacemaker analysis.
• Creation of directional activation maps and correlation analysis between ECG and ECGI parameters.

Main Results:

• Successful LBBAP implantation in all patients.
• ECGI provided rapid, visual assessment of interventricular activation during lead implantation.
• Specific sheath positions correlated with longer activation times and dyssynchrony; ECGI confirmed lead fixation effectiveness.

Conclusions:

• ECGI significantly aids conduction system device implantation by visualizing procedural steps and confirming lead position.
• ECGI facilitates assessment of physiological ventricular activation, potentially reducing fixation attempts.
• This technique is particularly valuable in patients with complex cardiac or non-cardiac anatomy.