Left bundle branch area pacing - restoring the natural order: A Case Report
Catalin Pestrea1, Alexandra Gherghina1, Florin Ortan1
1Department of Interventional Cardiology, Brasov County Emergency Clinical Hospital.
Medicine
|August 10, 2020
Summary
Left bundle-pacing offers a solution for patients with His-bundle pacing challenges. This His-Purkinje system pacing method effectively normalizes conduction and improves outcomes when His-bundle pacing is unsuitable.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His-bundle pacing is an emerging alternative for cardiac resynchronization therapy, showing promise in improving ventricular activation and QRS narrowing.
- However, high pacing thresholds or diseased His-Purkinje systems necessitate alternative pacing strategies.
Observation:
- A 77-year-old male presented with symptomatic 2:1 atrioventricular block and left bundle branch block morphology.
- European guidelines indicated a Class 1 indication for permanent double chamber cardiostimulation.
Findings:
- Initial His-bundle pacing attempts resulted in QRS narrowing but an unacceptably high pacing threshold.
- Repositioning the lead to capture the left bundle branch achieved complete conduction normalization.
Implications:
- Left bundle-pacing is a viable next step for His-Purkinje system pacing, addressing limitations of His-bundle pacing.
- This technique can overcome high pacing thresholds and conduction abnormalities, offering a more effective solution for specific patient groups.
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