The Lead Episode 136: A Discussion of Electrophysiological Characteristics of Lead Position Dependent Electrogram Uninterrupted Transition during Left Bundle Branch Pacing

Join Digital Education Committee Member and podcast host Jason T. Jacobson, MD, FHRS, along with this week's guest contributors, Gaurav A. Upadhyay, MD, FHRS and Pugazhendhi Vijayaraman, MD, FHRS for this exciting conversation!

This Heart Rhythm Journal article explores the electrophysiologic signatures that occur during left bundle branch pacing (LBBP) as lead position changes, with a focus on identifying "uninterrupted transition" patterns in recorded electrograms. The findings help clarify how subtle lead movement within the interventricular septum can alter electrogram morphology and capture behavior, improving clinicians' ability to confirm true conduction system engagement during implantation.

Read the article

Learning Objectives

• Describe the electrophysiologic basis of lead position–dependent electrogram changes observed during left bundle branch pacing.
• Differentiate uninterrupted transition electrogram patterns from other pacing capture transitions (e.g., septal capture vs LBB capture).
• Apply electrogram transition findings to improve procedural decision-making for confirming optimal lead placement during LBBP implantation.

Article Authors
Jiabo Shen, MD, Longfu Jiang, MD, Hao Wu, MD, Lu Zhang, MD, Hengdong Li, MD, Lifang Pan, MD

Podcast Contributors
Gaurav A. Upadhyay, MD, FHRS
Pugazhendhi Vijayaraman, MD, FHRS
Jason T. Jacobson, MD, FHRS

Host and Contributor Disclosure(s):

J. Jacobson

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical Inc.
• Stocks, Privately Held: Atlas 5D
• Research: CardioFocus, Inc.
• Membership on Advisory Committees: Abbott Medical, Johnson and Johnson

G. Upadhyay

• Honoraria/Speaking/Teaching/Consulting: Boston Scientific, Abbott, Medtronic, Biontronik, Zoll Medical Corporation

P. Vijayaraman

• Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Biotronik, Abbott Medical, Abbott
• Research: Medtronic
• Fellowship Support: Medtronic

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.