2.3 Implantation of the lead
Huang et al. have described in detail the process of left bundle branch pacing 4. In summary, this process consists of the following three steps. Firstly, the thickness and scar of interventricular septum were evaluated by Echo to improve the success rate of lead fixation. Secondly, the HBP location was determined and then identified as an anatomic marker for LBBP lead implantation, which is located on the line connecting the HBP lead position to the right ventricular (RV) apex, about 1–1.5 cm below the former3,4,7. Once the paced QRS morphology showed a “w” notch in V1, the lead was screwed in perpendicular to the RV septum surface. Thirdly, during screwing, as soon as the pacing pattern converted from LBBB to RBBB, and the stim-LVAT remained shortest and consistent so regardless of the output, indicating that the LBB was finally captured, the lead was fixed.