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Related Experiment Video

Updated: Jul 8, 2026

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures
09:13

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

Published on: April 21, 2013

Conduction Guided Intervention: A First-in-Human Study of CTA-Guided Targeting of Proximal Conduction System

Óscar Cano1, Justin T Tretter2, Tarikh Asyraf3

  • 1Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Ascires Hospital, Valencia, Spain.

Heart Rhythm
|July 6, 2026
PubMed
Summary

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Computed tomography angiography (CTA)-guided conduction system pacing (CSP) successfully targeted proximal conduction structures in 90% of patients. This novel workflow integrates cardiac CTA with patient-specific anatomy for improved His bundle and left bundle branch pacing.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Conduction system pacing (CSP) implantation is challenging due to difficulties in precisely targeting proximal His bundle and left bundle branch (LBB) structures.
  • Current techniques often struggle with accurate anatomical targeting, impacting procedural success.

Purpose of the Study:

  • To evaluate a novel computed tomography angiography (CTA)-guided workflow for precise, patient-specific targeting of proximal conduction system structures.
  • To assess the feasibility and efficacy of this CTA-guided approach in facilitating His bundle and LBB pacing.

Main Methods:

  • A prospective, first-in-human study enrolled 40 patients undergoing CSP.
  • The Conduction Guided Intervention (CGI) workflow integrated pre-procedural cardiac CTA, patient-specific conduction system reconstruction, and real-time fluoroscopic overlay.
Keywords:
Conduction system pacingHis bundle pacingcardiac computed tomography angiographyimage-guided interventionleft bundle branch pacingproximal conduction system pacing

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Last Updated: Jul 8, 2026

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Published on: April 21, 2013

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  • Procedural success was defined by implantation at a target proximal conduction site, while clinical success required effective pacing with QRS correction.

    • Main Results:

    • Procedural success was achieved in 95% of patients (38/40).
    • Significant inter-individual anatomical variability in the proximal conduction system was observed via CTA.
    • Final pacing sites included distal His pacing (35%) and proximal LBB trunk pacing (55%), achieving clinical success in 90% of patients.

    Conclusions:

    • CTA-guided conduction system mapping is a feasible technique for intentional targeting of proximal conduction structures during CSP.
    • Integrating patient-specific anatomical data from CTA complements traditional fluoroscopic and electrophysiological guidance.
    • This approach shows promise for improving the accuracy and success rates of conduction system pacing.