Safety Assessment of Coronary Arteries During Left Bundle Branch Area Pacing

Objective: This study aimed to investigate the relationship between the location of implantation of the Left Bundle Branch Area Pacing (LBBAP) electrode and the coronary artery and to assess the safety of LBBAP surgery. Methods: Patients who underwent the LBBAP procedure and coronary angiography (CAG) at the Second Affiliated Hospital of Nanchang University between January 1, 2019 to October 1, 2020 were included. We read the patient’s LBBAP and CAG imaging data and used the nine-partition method to measure the vertical distance from the tip of the pacing electrode to each coronary artery in multiple projection positions during the ventricular systolic period. Changes in the ST-T segment in the electrocardiogram, serum troponin and myocardial enzyme profiles were observed before and after the LBBAP surgery. Results: Overall, 50 patients were evaluated. The average vertical distances from the electrode tip to the left anterior descending branch (LAD), right posterior coronal descending branch (PD), left posterior ventricular branch (PL) were 19.69±8.72 mm, 26.09±8.02 mm, and 21.11±7.86 mm, respectively. The minimum were 5.28 mm, 9.51 mm and 8.69 mm, respectively. CAG in all patients showed no significant injury to the ventricular septal branch. And there were no elevated serum troponin or cardiac enzyme profiles. Conclusions: This study suggested that the coronary arteries were safest when the LBBAP electrodes were placed within a rectangle formed by the PM, M, PI, and MI center points. The PM was the ideal position to implant the LBBAP electrodes, which had a low risk of coronary vascular injury.