We read with great interest the paper by Tian et al1 on the effects with left bundle branch pacing (LBBP) on RV function. The authors are to be congratulated on their study, which further adds to our understanding of LBBP. However, the authors did not report if the atrioventricular delay (AVD) was optimized for each patient. This is a key detail for interpreting these results. Previous experimental2 and simulation3 studies have shown that the effect of LBBP on RV activation is highly dependent on the AVD, with AVD optimization allowing fusion between intrinsic RV and LV paced activation, reducing the right bundle branch block pattern induced by LBBP alone.

Targeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation may reduce atrial fibrillation (AF) recurrence. Isoproterenol infusion and cardioversion of spontaneous or induced AF can provoke NPVTs but typically require vasopressor support and increased procedure time.

Targeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation may reduce atrial fibrillation (AF) recurrence. Isoproterenol infusion and cardioversion of spontaneous or induced AF can provoke NPVTs but typically require vasopressor support and increased procedure time.

Pulsed field ablation (PFA) is emerging as an efficient, effective and safe energy source to achieve pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF).1,2 One of the most appealing aspects of PFA compared to conventional thermal ablation sources is the differential tissue sensitivity with reported tissue-specific ablation thresholds.3,4 Pre-clinical studies with different PFA platforms have suggested that selective myocardial ablation can be achieved, with sparing of adjacent non-myocardial tissue such as nerves, vascular structures and esophageal tissue.

Two or three decades ago, many considered the standard 12-lead electrocardiograms (ECGs) similarly as theoretical physics was seen at the end of 19th century: of some practical use but dull since everything was known making noticeable advances impossible. Indeed, various medical schools stopped studying and teaching ECGs, believing that only diagnostics by standard equipment was of any value.

We read with great interest the paper by Tian et al1 on the effects with left bundle branch pacing (LBBP) on RV function. The authors are to be congratulated on their study, which further adds to our understanding of LBBP. However, the authors did not report if the atrioventricular delay (AVD) was optimized for each patient. This is a key detail for interpreting these results. Previous experimental2 and simulation3 studies have shown that the effect of LBBP on RV activation is highly dependent on the AVD, with AVD optimization allowing fusion between intrinsic RV and LV paced activation, reducing the right bundle branch block pattern induced by LBBP alone.