Pace mapping options with stylet driven pacing leads
In contrast, using stylet-driven leads, the novel approach we are
proposing offers the possibility of continuous monitoring of unipolar
pacing characteristics in all patients at a predetermined rate, allowing
thus for an improved control during the transseptal positioning of the
lead. As demonstrated in the present study, we found that pacing from
the inserted lead stylet is feasible and reliable and is associated with
a very low risk of implant failure due to inadequate progression of the
lead or sheath dislodgement. The safety of this approach is further
demonstrated by the absence of perforation into the LV cavity. As show
in our study continuous LS pacing during implantation allows for
real-time monitoring of the transition of QRS morphology towards a RBBB
morphology, guided by the pLVAT value. (Figure 5)
Moreover, continuous monitoring of the pacing impedance during lead
implantation might allow for the early detection of inadvertent
helix-retraction, which would be associated with a significant increase
in impedance during the transseptal screwing.