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.