Simplifying Left Bundle Branch Area Pacing: A Novel Stylet‐Guided Technique and Its Feasibility Assessment
Geer Sheng, Songqing Yang, Haoruo Zhang, Yuran Chen, Haoran Jing, Yanfeng Tian, Chunlin Gong, Jiaoyue Zhong, Siting Hong, Jian Kang, Zhaojun WangObjective
To evaluate the feasibility of the modified probe technique for cardiac physiologic pacing (CPP).
Method
A retrospective analysis was conducted on symptomatic bradycardia patients undergoing CPP via the modified probe technique at the First Affiliated Hospital of Harbin Medical University (July–September 2024). The technique uses three‐dimensional (3D) septal modeling: A straight guidewire is first positioned at the optimal septal pacing site to guide ventricular lead implantation. Baseline data (past medical history, QRS duration, echocardiography) were collected. Intraoperative variables (bundle branch potentials, Sti‐LVAT, pacing threshold, impedance), postoperative complications (from EMR), and follow‐up threshold/impedance were recorded.
Results
This study included 10 patients (60% male; mean age 68 ± 10.84 years) with atrioventricular block or sick sinus syndrome. LBBAP was successful in all cases, with Sti‐LVAT ≤ 80 ms in 8 patients and 80–100 ms in 2. Postimplantation QRS duration significantly decreased (111.6 ± 27.29 ms vs. 130.6 ± 30.41 ms). No complications such as ventricular septal perforation, right bundle branch injury, electrode dislocation, and pericardial effusion were observed in this group. At 3 months, most pacing thresholds remained < 1.5 V; lead impedance decreased intraoperatively and stabilized thereafter. No complications occurred.
Conclusion
The modified probe method uses the original standard straight wire as a probe to conduct left bundle branch area pacing, which simplifies the surgical process of physiological pacing and improves the controllability of intraoperative operation. The parameters of the lead are stable during the follow‐up period, and the clinical application is feasible.