{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:53:56Z","timestamp":1791402836085,"version":"4.3.3"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Left bundle branch pacing (LBBP) involves the deployment of the lead deep inside the septum. Penetration of the septum by the lead depends on the texture of the septum, rapidity of rotations, operator experience, and implantation tools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The aim of our study was to assess the behavior of the lumenless lead during rapid rotations and the physiological property of the interventricular septum(IVS) during LBBP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing LBBP between January 2021 and December 2022 were retrospectively included in the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 255 attempted patients, 20 (7.9%) had procedural failure(no LBB capture\u2014four, inability to penetrate septum\u2014seven, and dislodgements after sheath removal\u2014nine). Septal penetration achieved in 248\/255 patients (97.2%). Lead movement inside the IVS was assessed by lead traverse time. Based on the behavior of the IVS (<jats:italic>n<\/jats:italic>\u2009=\u2009255), three different responses were noted. Type\u2010I response(normal\/firm septum) in 93.7% (<jats:italic>n<\/jats:italic>\u2009=\u2009239) characterized by constant and progressive movement of lead. Neither perforation nor further change in premature\u2010ventricular\u2010complex morphology beyond M\u2010beat were observed despite additional few unintentional rotations indicating the protective mechanism of LV\u2010endocardium. Type\u2010II response(soft\/cheesy septum) in 3.5% (<jats:italic>n<\/jats:italic>\u2009=\u20099) characterized by hyper\u2010movement of lead without resistance due to altered texture of septum and poor LV subendocardial barrier resulting in perforation. No patients in this group had LV dysfunction or associated coronary artery disease. In type\u2010III response, seen in 2.8% (<jats:italic>n<\/jats:italic>\u2009=\u20097), lead could not be penetrated due to scar in IVS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Three different patterns of responses were observed during LBBP. The most distinct type\u2010ll response was associated with soft\/cheesy septum with hyper\u2010movement of the lead predisposing for future dislodgments in patients without structural heart disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16057","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T10:02:57Z","timestamp":1694426577000},"page":"2246-2254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Observations of interventricular septal behavior during left bundle branch pacing"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7059-425X","authenticated-orcid":false,"given":"Shunmuga Sundaram","family":"Ponnusamy","sequence":"first","affiliation":[{"name":"Department of Cardiology Velammal Medical College Madurai 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