Guidance on left bundle branch pacing using continuous pacing technique and changes in lead V1 characteristics under real-time monitoring

BACKGROUND: The changes in the morphology and characteristics of the V1 leads during left bundle branch capturing still need to be fully understood. OBJECTIVE: This study aims to provide some suggestions about the LBB capture process through the morphology and characteristics of the V1 lead. METHOD: LBBP using the continuous pacing and morphology monitoring technique during screw-in using a revolving connector (John Jiang's connecting cable). The morphology and features of V1 leads are recorded by continuous monitoring technology. RESULTS: The most common morphology in the LVSP stage is QR, while in the NS-LBBP (low output) stage and the NS-LBBP (lower output) stage, it is rSR. In the S-LBBP stage, it is rsR. The predominant morphology is with r/R waves in S-LBBP, which includes variations like rSR, rsR, rSr, rsr, rR, rs, rS, and R type, making up 96.7% of the total. The r waves in lead V1 are associated with agitated myocardium conducted from the left bundle branch. CONCLUSION: The initial r-wave in lead V1 may be a marker during the follow-up of patients with selective LBB capture.