SIMPLIFIED EKG ONLY METHOD TO ACHIEVE PHYSIOLOGIC PACING

BackgroundHis pacing (His-P) and left bundle branch (LBB-P) are new modalities to obtain a more physiologic (PP); they require however, tools skills. We describe simplified method achieve LBB-P, using only 12-lead EKG guide lead deployment; mid septum (not too anterior close His area or LV summit not posterior is sought).Methods ResultsFrom our cohort of 211 attempts (2019-2022), we extracted all patients (pts) with detailed available 12 during implant. His-P LOT/HOT-CRT pts were excluded. reviewed the presence two features: inferior discordance (at least one from II, III aVF different polarity compared others) isodiphasic QRS at beginning 3830 Medtronic screwing, typical LBB capture morphology after final position. Leads screwed until LBB-P was obtained bipolar unipolar produced same morphology. A total 161 tracings analyzed. Pts 56% males; median age 79 +/- 8.5 years. Indications were: SSS 25%, AV block 41% (including 8 post TAVR), Pacemaker induced cardiomyopathy (PIMC) 27% node ablation in 7%. Success (defined as shorter than 140ms LVAT 90ms, 20% reduction width) achieved 93.2% pts. Procedural time (pts in-out) 88min (+/- 37min). Perforation confirmed when aVL has aVR there monophasic R wave V1 (mostly orientation apical sites tempted). Basal versus positions easily differentiated looking normal progression waves precordial leads.Conclusion sought). Methods leads. From Conclusion