Fluoroscopic view of left bundle branch area pacing lead placement

Fluoroscopic view of the heart during implantation of a left bundle branch area pacing lead. A delivery sheath was extended from the left subclavian vein access site to the RV septum. Then, an active fixation pacing lead with a fixed helix at the tip was advanced and fixed deep in the RV septum. The position of the lead was confirmed with iodinated contrast injection, which is seen here at the right of the edge of the spine. The proximal pacing electrode is still within the sheath near the tip. Pacing from the distal electrode resulted in capture of the left bundle branch that travels along the left side of the ventricular septum. Also seen is a J-tip guidewire that was used subsequently to place the atrial lead.