An Anatomical CT-Based Framework for Optimizing Left Bundle Branch Area Pacing of the Human Cardiac Conduction System

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Left bundle branch area pacing (LBBAP) success relies on lead proximity to the left bundle origin.
• Current fluoroscopic guidance lacks precision due to anatomical variations.

Purpose of the Study:

• Develop a CT-based framework to enhance LBBAP targeting accuracy.
• Identify optimal lead positions for conduction system proximity while avoiding critical structures.

Main Methods:

• Created 3D models from 27 patients' coronary CT scans.
• Simulated lead placement along the left bundle system at varying distances from the tricuspid annulus.
• Measured vertical displacement relative to a His-to-RV apex reference line.

Main Results:

• Targets at 20 mm from the tricuspid annulus clustered near the His level.
• Septal targets showed minimal vertical displacement (-1.6±10.8%), indicating proximity to the His bundle.
• Septal fascicular targets offered the best feasibility and precision, averaging 18.9±4.5 mm from left bundle origins.

Conclusions:

• A CT-derived framework can effectively identify septal fascicle regions for LBBAP.
• These regions represent practical targets for achieving optimal proximity to the conduction system.