Guidance on left bundle branch pacing using continuous pacing technique and changes in lead V1 characteristics under real-time monitoring

Abstract

BackgroundThe changes in the morphology and characteristics of the V1 leads during left bundle branch capturing still need to be fully understood.ObjectiveThis study aims to provide some suggestions about the LBB capture process through the morphology and characteristics of the V1 lead.MethodLBBP using the continuous pacing and morphology monitoring technique during screw-in using a revolving connector (John Jiang's connecting cable). The morphology and features of V1 leads are recorded by continuous monitoring technology.ResultsThe most common morphology in the LVSP stage is QR, while in the NS-LBBP (low output) stage and the NS-LBBP (lower output) stage, it is rSR. In the S-LBBP stage, it is rsR. The predominant morphology is with r/R waves in S-LBBP, which includes variations like rSR, rsR, rSr, rsr, rR, rs, rS, and R type, making up 96.7% of the total. The r waves in lead V1 are associated with agitated myocardium conducted from the left bundle branch.ConclusionThe initial r-wave in lead V1 may be a marker during the follow-up of patients with selective LBB capture.