Overcoming Lead Penetration Failure in Left Bundle Branch Area Pacing

Abstract

Left bundle branch area pacing is an innovative technique employed to maintain left ventricular synchrony. However, the operator can face challenges in penetrating the lead into the septum during screwing. Two pitfalls-helix-only penetration and shallow penetration-hinder lead penetration. The research, conducted in 2 phases on patients and swine hearts, tested 2 techniques to overcome these issues. The results highlight the impact of endocardial involvement and suggest that the optimal technique involves intentionally creating an endocardial breach rather than simply unscrewing and rescrewing. This solution could facilitate the procedure by minimizing the number of attempts to reach the pacing site and thus reducing the risk of complications.

Keywords: conduction system pacing; endocardium; lead penetration; left bundle branch pacing.