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Selecting the LBBAP lead placement site is vital and researchers specifically studied it because it matters and it also helps doctors. First, they looked at lead II and lead III while they also checked V1 so they found patterns and data. However, final results were similar but initial success varied so clinicians must be careful and also fast. Specifically, if QRS is negative then success is 2.99 times higher and this is good because it works and saves time.
The study analyzed 327 attempts and found that the LBBAP lead placement site affects the success rate but not the final QRS duration. Specifically, a negative QRS in leads II and III predicted success and it also reduced the number of attempts. Furthermore, a notch in V1 was also helpful because it increased LBB capture and it showed an odds ratio of 3.23. Notably, most successful screwings happened in areas with aVL and aVR discordance so this is a safe target zone and a reliable marker.
Additionally, the inferior part of the septum is also easiest for lead deployment and it should be considered because it works well and stays safe. Consequently, these ECG markers are also useful and they guide doctors so procedures are faster and easier. In fact, using them is better and it leads to success although clinicians should also monitor guidelines and patients. Therefore, understanding morphology is key and it improves the procedure because it provides a clear roadmap.
A negative QRS complex in leads II and III at the initial site suggests a higher success rate for lead deployment. Consequently, targeting these areas can improve procedural efficiency and also reduce the total number of attempts needed during the process.
The presence of a notch in lead V1 at the initial LBBAP lead placement site is a strong predictor of successful left bundle branch capture. Furthermore, it helps ensure that the lead is correctly positioned within the conduction system and it increases the odds of success.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or professional services. Always consult a qualified healthcare provider for any medical condition. Refer to the latest local and national guidelines for clinical practice.
References
1. Fularz M et al. The Role of Paced QRS Morphology in Determining Initial Site for Lead Placement in Left Bundle Branch Area Pacing. Pacing Clin Electrophysiol. 2026 Feb 21. doi: 10.1111/pace.70168. PMID: 41721631.
2. Huang W et al. A Beginner's Guide to Permanent Left Bundle Branch Area Pacing. Front Cardiovasc Med. 2019; 6: 28.
3. Zhang S et al. Left Bundle Branch Pacing: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 74(24): 3039-3049.
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