Abstract
Right ventricular (RV) pacing-induced dyssynchrony may precipitate heart failure (HF) with impaired left ventricle (LV) systolic function in susceptible patients. LV pacing via coronary sinus or endocardially via transseptal approach has its limitations due to anatomy and requirement for long term anticoagulation respectively. His pacing is promising, as it engages the natural conduction system. However, in patients with LBBB, His pacing may be able to normalize LBBB in about 50% of patients. Pacing the LBB area via the right ventricle has rapidly evolved however engaging the LBB can be challenging due to restrictive short active fixation helix. An alternative is to engage the Purkinje network in the LV septum via the membranous septum from the right atrium (RA) to LV. We sought to determine the anatomic dimensions that could safely guide placement of this RA-LV lead bounded by COMiT (boundaries: Coronary sinus(CS), left ventricular outflow tract (LVOT), Mitral annulus (MA), Tricuspid annulus (TA)).
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