Introduction
Left bundle area pacing (LBP) promises a revolution for treating
bradycardia and achieving cardiac resynchronization1–4,
but has lower success rates in ischemic cardiomyopathy2,3,5The reasons are not clear but may include difficulty in reaching the
left bundle area or stimulating it adequately. For such patients,
operators therefore sometimes aim for His bundle pacing accepting the
potential for higher capture thresholds and lower amplitude R waves.
The technique for LBP involves deploying the lead through the
interventricular septum, which may be scarred in patients in patients
with ischemic cardiomyopathy. Late gadolinium enhancement (LGE) on MRI
is a reliable way of detecting, localizing and quantifying myocardial
scar6,7non-invasively. However, the 3830 SelectSecure lead (Medtronic,
Minneapolis, MN) when implanted for LBP is currently not MRI
conditional, and therefore post-procedure scanning would be more
challenging.
We therefore conducted a systematic protocol of MRI scanning before
attempting LBP, to test whether localized late gadolinium enhancement
might reveal the mechanism of the difficulties seen in some patients.