Arrhythmias & electrophysiologyCohort study
Distinct intracardiac electrogram waveforms with perforation during left bundle branch area pacing implantation
- Retrospective cohort study
Authors' conclusion
Beyond COI amplitude, additional iEGM waveform parameters may be used to evaluate the presence of LBBAP perforation
Study context
- Population
- Consecutive patients with perforation during left bundle branch area pacing (LBBAP) implantation
- Participants
- 92 patients
- Exposure
- iEGM waveforms during perforation vs at final lead position
- Outcome
- Unipolar iEGM waveforms during perforation vs final lead position
Main finding
As reported in the abstract
Sensed COI amplitude, unfiltered channel
P < 0.0001
- Narrow QRS/non-LBBB: wide negative (QS) waveforms during sensing
- 67%
- LBBB/paced rhythm: positive (wide R/RS) morphologies
- 93%
Observational data: associations, not effects.
Further findings
Sensed Q or S amplitude > current of injury (COI) amplitude for diagnosing perforation (narrow QRS/non-LBBB subgroup)
- Sensitivity
- 86%
- Specificity
- 93%
Macroperforation (loss of capture, n = 27) vs microperforation (preserved capture, n = 65)
- Macroperforation: significantly lower COI amplitudes, more frequent QS morphology, rarer sharp multiphasic components in filtered-channel ventriculogram
Original publication
Distinct intracardiac electrogram waveforms with perforation during left bundle branch area pacing implantation. Europace. Published 17 February 2026. doi:10.1093/europace/euag010
Summarised from the published abstract; every number is checked against it