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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Left Posterior Fascicular Pacing.

Shunmuga Sundaram Ponnusamy¹, Thabish Syed¹, Surya Kumar¹

¹Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.

The Journal of Innovations in Cardiac Rhythm Management

|May 26, 2021

Summary

Left bundle branch pacing (LBBP) is an alternative to His bundle pacing. Left posterior fascicular pacing offers a solution when LBBP is unsuccessful, demonstrating successful capture via electrocardiography.

Keywords:

Left bundle pacing peak left ventricular activation time posterior fascicle

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Area of Science:

Cardiology
Electrophysiology
Cardiac Pacing

Background:

Left bundle branch pacing (LBBP) is an emerging alternative to His bundle pacing, offering improved outcomes.
Existing studies highlight the safety, efficacy, and electrophysiological benefits of LBBP, with success rates between 80.5% and 94%.

Observation:

The left posterior fascicle comprises broad fibers extending inferiorly and posteriorly.
The left anterior fascicle is a thin, tendon-like structure.

Findings:

A case report details a 70-year-old male who underwent left posterior fascicular pacing after failed LBBP.
Surface 12-lead electrocardiography confirmed left posterior fascicular capture, showing fascicular potential and a left anterior hemiblock pattern.

Implications:

Left posterior fascicular pacing presents a viable alternative when standard LBBP implantation fails.
This technique may expand pacing options for patients with conduction system disease.