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.