Simplifying Physiological Left Bundle Branch Area Pacing Using a New Nine-Partition Method

Background: Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. Methods: A simplified approach ("9-partition method") was explored to perform LBBaP. In this method, a right anterior oblique 30 degrees fluoroscopic image of the ventricle was divided into 9 sections ("3 x 3" partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. Results: The mean age was 68.53 +/- 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 +/- 19.51 minutes vs 70.68 +/- 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 +/- 5.34 minutes vs 10.54 +/- 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 +/- 1.61 minutes vs 2.75 +/- 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 +/- 3.00 minutes vs 7.67 +/- 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. Conclusions: Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system.