Use of radiofrequency energy to facilitate deep septal penetration with a left bundle branch pacing lead
Left bundle branch area pacing (LBBAP) is a rapidly developing pacing technique intended to deliver more physiologic activation of the ventricles during permanent pacing. A number of obstacles impede the successful implantation of LBBAP leads, reducing the overall procedural success rate. The entanglement effect, originally described by our group on the basis of a human cadaver model,1 is caused by an initial fibrous endocardial barrier that prevents septal penetration. Overcoming this barrier, when its fibrous elements are wrapped around the lead tip, proved to be impossible with manual lead rotation and required lead repositioning.
