Arrhythmias & electrophysiology
Transseptal Transition Patterns During Left Bundle Branch Area Lead Implantation
Authors' conclusion
Capture of left bundle branch during lead penetration is a beat-to-beat phenomenon. Two transseptal transition patterns were identified: 1) sudden, which is typical for obtaining LBBP; and 2) gradual, which is typical for obtaining LVSP. A sudden COI drop, a very observable phenomenon, also identified reaching the left subendocardial area.
Study context
- Population
- Pacemaker recipients undergoing left bundle branch area lead implantationanalysed
- Participants
- 212 recipients
- Comparison
- Sudden vs gradual transseptal transition pattern for diagnosing left bundle branch pacing (LBBP) vs LVSP
- Outcome
- Patterns of continuous QRS, ST-T and COI change for monitoring lead depth and determining capture type (LBBP vs LVSP)
Performance
As reported in the abstract
Diagnosis of LBBP
| Test or model | Value | Sensitivity | Specificity |
|---|---|---|---|
| Sudden transition pattern | 80.7% | 98.8% | 81.2% |
Sudden transition pattern
Value80.7%
Sensitivity98.8%
Specificity81.2%
- LBBP obtained
- 77.4%
- LVSP obtained
- 22.6%
- Beat-to-beat phenomena, LBBP (mean ± SD)
- 4.7 ± 2.1
- Beat-to-beat phenomena, LVSP (mean ± SD)
- 0.2 ± 0.6
Further findings
- Patients with sudden current of injury (COI) drop
- 53.9%
- COI before drop (mV)
- 29.4 ± 8.5
- COI after drop (mV)
- 12.8 ± 4.9
- LBBP simultaneously obtained
- 92.7%
Original publication
Transseptal Transition Patterns During Left Bundle Branch Area Lead Implantation. JACC Clin Electrophysiol. Published 9 October 2024. doi:10.
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