1) Where is the target site for LBBAP lead deployment?
The mid‑to‑basal interventricular septum on the right side, with a trajectory toward the left bundle area; depth is advanced through the septum while monitoring ECG changes and impedance.
2) How is appropriate depth confirmed?
Indicators include a transition to LBB‑like ECG morphology, stable impedance, lack of perforation signs, and, when available, demonstration of LBB potentials and output‑dependent capture transitions.
3) What are key complications to watch for?
Septal perforation into the LV cavity, lead helix fracture or entanglement, rising thresholds, septal hematoma, and rare coronary injury; fluoroscopy and echocardiography can aid detection.
4) Does LBBAP pose tricuspid valve risks?
Because the lead traverses the tricuspid valve, there is potential for leaflet interaction; careful positioning and minimizing lead tension reduce regurgitation risk compared with some RV lead paths.
5) What peri‑procedural imaging helps?
Fluoroscopy with LAO/RAO views to assess septal trajectory; intracardiac echo or transthoracic echo can confirm septal position and rule out pericardial effusion if symptoms arise.