In the context of LBBAP, what does the morphology of V1 resemble as placement approaches LBB?

In the context of Left Bundle Branch Area Pacing (LBBAP), as the pacing lead approaches the Left Bundle Branch (LBB), the morphology seen in lead V1 typically resembles a qR or rsR' shape. This indicates that the electrical activation pattern is changing due to the location of the pacing lead.

The presence of a qR or rsR' morphology in V1 signifies that the pacing is effectively capturing the His-Purkinje system, leading to a more physiological pattern of ventricular activation. This is critical for achieving proper synchronization of the ventricular contraction and maintaining optimal cardiac output. The transition to this morphology demonstrates the successful conduction of impulses through the left bundle branch area, which is essential for maintaining a normal ventricular activation pattern.

As the pacing lead gets closer to the LBB, one can anticipate that the electrical impulses will take on a characteristic shape that aligns with a more normal conduction physiology, thereby confirming effective placement of the pacing system.