Feasibility and efficacy of dual cathode modality in left bundle branch pacing

Left bundle branch pacing (LBBP) is an increasingly popular physiological pacing strategy for its advantage in left ventricular (LV) function through maintaining or restoring LV electrical and mechanical synchrony. 1 Hua W. Fan X. Li X. et al. Comparison of left bundle branch and His bundle pacing in bradycardia patients. JACC Clin Electrophysiol. 2020; 6: 1291-1299 Crossref PubMed Scopus (60) Google Scholar However, LBBP can result in right bundle branch block (RBBB) and subsequent negative effects on right ventricular (RV) function. Notably, the simultaneous capture of the tip and ring electrode in LBBP could correct this iatrogenic RBBB and realize better electrical synchrony. 2 Lin J. Chen K. Dai Y. et al. Bilateral bundle branch area pacing to achieve physiological conduction system activation. Circ Arrhythm Electrophysiol. 2020; 13e008267 Crossref Scopus (17) Google Scholar Clinically, although the ring electrode could pace the surrounding myocardium by anodal capture, the relatively high pacing threshold would increase power consumption and consequently shorten the pacemaker’s life. Therefore, dual cathode pacing (DCP) in LBBP, which use the tip and ring electrodes as cathode simultaneously, is a possibly economical modality to correct iatrogenic RV desynchrony.