ELECTROCARDIOGRAPHIC CHARACTERISTICS WITH LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER PROSPECTIVE STUDY

BACKGROUND Pure left bundle branch (LBB) capture should result in typical RBBB (rsR') morphology. However, numerous paced QRS morphologies are observed during LBB area pacing (LBBAP). There are limited papers describing the various electrocardiographic (ECG) morphologies seen with LBBAP. Objective: To evaluate the various ECG characteristics encountered in LBBAP. METHODS AND RESULTS Patients referred for pacemaker implantation between 08/2019-01/2021 were considered for LBBAP. LBBAP was performed by implantation of a Medtronic 3830 lead 2 cms distal to His and confirmed by previously published criteria. Paced QRS morphology and QRS axis was analyzed. Baseline, ECG, and implantation characteristics are summarized in table 1. Of 264 LBBAP ECGs, the most common morphology seen during unipolar tip pacing was an incomplete RBBB pattern (qR) in V1 in 165 (69.9%) patients. rSR' pattern was seen in 9 (3.2%) and a narrow QS pattern in 60 (21.5%) patients. CONCLUSION Various ECG morphologies may be encountered during successful LBB area capture and are associated with similar QRSd, pacing characteristics and short-term lead performance. These morphologies are due to capture of various structures (RV or LV septum, capture of LBB, LPF +/- RBB) and are likely due to virtual-electrode effect.