Abstract
Introduction: Left bundle branch pacing (LBBP) is a developing
method of native conduction pacing, but cases of injury to the septal
perforator arteries during implantation have been reported. Knowing the
distance between the His bundle and the first septal perforator artery
can help operators implant LBBP leads more safely
Methods: Using previously performed coronary CT angiography
(CCTA) studies, the distance between the His bundle and the first septal
perforator was measured.
Results: A total of 50 CCTA studies were included. The mean
distance from the His bundle to the first septal perforator (His-SP)
along the line connecting the His bundle to the RV apex (His-RV apex)
was 27.17 ± 7.7 mm with a range of 13.0 to 44.7 mm. The distance was
greater than 2.0 cm in 90% of patients. To standardize this distance
among patients with varying cardiac structures, the ratio between the
His-SP distance and the His-RV Apex distance was also measured. The mean
His-SP:His-RV Apex was 0.302 and the median was 0.298. 86% of patients
had a ratio of greater than 0.20.
Conclusion: Using this information, operators can aim to
implant LBBP leads within 2.0 cm of the His bundle or 20% of the
distance between the His bundle and the RV apex with minimal risk of
causing vascular injury.