What is a common characteristic of the R wave during LBBAP?

In the context of left bundle branch area pacing (LBBAP), the R wave is indeed characterized by an enlarged appearance, reflecting the effective pacing of the ventricles through a more physiologic approach compared to traditional right ventricular pacing. This enlargement occurs because LBBAP allows for better synchronization of ventricular contraction, enhancing the overall pacing output and improving hemodynamic performance.

At the same time, one of the advantages of LBBAP is that it typically does not suffer from oversensing issues, as the pacing action is more aligned with the natural conduction pathway. This means that the R wave's morphology, indicative of effective ventricular depolarization, remains distinct and is not blunted by oversensing artifacts. The clear and pronounced R wave is crucial for identifying effective pacing and monitoring the patient’s cardiac function after implantation.