Left bundle branch pacing (LBBP) provides physiological activation with stable pacing parameters. However, there is a paucity of data on direct assessment of lead stability.

Bachmann bundle (BB) area pacing has recently been redefined on the basis of local electrogram signature and stringent P-wave criteria.1 BB area pacing has been shown to improve biatrial synchronous activation in patients with significant interatrial conduction delay.2 BB area pacing defined by P-wave criteria has been associated with decreased atrial arrhythmia burden, recurrence, and de novo incidence compared with right atrial septal pacing and right atrial appendage pacing.3 We performed BB area pacing and left bundle branch pacing in an 80-year-old man with recurrent persistent atrial fibrillation (AF) and tachy-brady syndrome.

Areas of abnormal and/or heterogenous conduction velocity (CV) are important ablation targets for ventricular tachycardias. Yet, precise assessment of CV in clinical contact mapping remains challenging. Numerous different CV estimation methods have been proposed.

Studies evaluating the systematic use of cardiac computer tomography (CCT) for the pre-procedural assessment of myocardial fibrosis are limited and their implementation in the electrophysiology workflow has not been extensively described.