Quantitative CT Lead Localization Reveals Proximal Left Bundle Targeting Facilitates Superior Physiologic Pacing

The authors aimed to determine whether a quantitative CT-based classification of conduction system pacing (CSP) lead positions could improve physiological pacing outcomes by identifying the optimal lead placement along the conduction axis. Their findings indicate that proximal lead positioning (within 25 mm of the His bundle) significantly enhances near-native paced activation compared to distal placements, highlighting the necessity of quantitative imaging for accurate lead localization, as traditional methods like ECG and procedural labels were insufficient.