1 INTRODUCTION
Currently, the pacing methods mainly used in clinical treatment include
right ventricular pacing (RVP), His bundle pacing (HBP) and LBBAP. Among
them, LBBAP is a new physiological pacing method that can effectively
narrow the width of the QRS wave, synchronize mechanical contraction of
the left ventricular myocardium, improve cardiac function, and overcome
atrial fibrillation defects and heart failure caused by RVP
pacing[1]. However, LBBAP electrodes should
permeate from the right ventricular septum to the left ventricular
septum subendocardium. Therefore, there is a potential risk of damaging
the coronary arteries and veins, such as the ventricular septal, the
left anterior descending branch (LAD), the right posterior coronal
descending branch (PD) and the left posterior ventricular branch (PL)
during the implantation of LBBAP electrodes. Furthermore, during the
LBBAP procedure, Qi P et al.[2] found that the
pacemaker electrode penetrated the interventricular septal vessels which
were successfully visualized upon injecting the contrast medium into the
C315 His sheath. In the previous reports, pacemakers implanted in the
interventricular septum can damage the anterior descending artery or
interventricular septal artery. For example, some studies have found
that ventricular septal pacing electrodes can compress the anterior
descending artery to different degrees, resulting in different degrees
of myocardial infarction[3-6]. However, to our
knowledge, there are no studies concerning LBBAP electrodes and coronary
vascular injury. Therefore, this study aimed to evaluate the risk of
intraoperative coronary injury by measuring the adjacency relationship
between the tip of LBBAP electrodes and the coronary arteries to provide
a reliable clinical reference for the safe implantation of the LBBAP.