Arrhythmias & electrophysiology
Distinct intracardiac electrogram waveforms with perforation during left bundle branch area pacing implantation
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.
Summarised from the published abstract; every number is checked against it