{
  "abstract": "Background Left Bundle Branch Area Pacing (LBBAP) is emerging as the preferred Conduction System Pacing (CSP) modality, receiving guideline backing in a number of clinical scenarios. However, there is a considerable learning curve, and, even in experienced hands, success rates are only between 81%-92%. Additional techniques to increase success rates are essential to permit widespread adoption.We aimed to facilitate successful LBBAP by using right ventriculography (RVG) via a power-injector to provide a greater understanding of right ventricular (RV) anatomy.Methods All procedures (n=5) were performed by a left axillary approach. A 5F pigtail catheter was guided into the RV. The catheter was connected to a power-injector, with RVG performed with 25ml of contrast delivered at 15ml/s.Images were taken in the left anterior oblique (LAO) and right anterior oblique (RAO) views. SelectSecure 3830 pacing leads (Medtronic, 4.1 F, 69cm) were used via a fixed curve C315-HIS guide (Medtronic).Using the RAO ventriculogram [figure 1a] to identify the tricuspid valve summit, an initial lead position in the basal-mid RV septum (15–20mm from the TVS towards the RV apex) was selected. Using the LAO ventriculogram [figure 2a] the delivery catheter was placed perpendicular to the interventricular septum with the lead oriented 10–40° superiorly to the horizontal plane. The lead was then advanced towards the left ventricle with confirmation of CSP as per the EHRA consensus document.Results All patients underwent successful LBBAP with final lead positions demonstrated in figures 1b and 2b.Conclusion Our series demonstrates how RVG via a power-injector allows total opacification of the RV, providing a greater understanding of the variable RV anatomy which might be useful in facilitating successful LBBAP. It’s particularly useful for training less experienced operators, potentially reducing the learning curve, as well as procedural and fluoroscopic times.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Sussex NHS Foundation Trust, UK"
      ],
      "name": "James Smethurst"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, London, UK",
        "Guy’s and St Thomas NHS Foundation Trust, London, UK"
      ],
      "name": "Mansimran Singh Dulay"
    },
    {
      "affiliations": [
        "Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Ahran Arnold"
    },
    {
      "affiliations": [
        "St Richard’s Hospital, University Hospitals Sussex NHS Foundation Trust, Chichester, UK"
      ],
      "name": "Mark Tanner"
    }
  ],
  "title": "4-028 Right ventriculography via a power-injector to guide conduction system pacing: a case series",
  "uid": "25f868b2-eece-5b15-8997-0d558d5cbde3"
}