Left Bundle Branch Pacing: Unexpected Resynchronization Effect of Anodal Capture
Ronpichai Chokesuwattanaskul1,2,3,4, Krit Jongnarangsin1
1Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, MI, USA.
The Journal of Innovations in Cardiac Rhythm Management
|March 23, 2022
Summary
Anodal capture stimulation during left bundle branch pacing can achieve cardiac resynchronization therapy. This effect was observed in a patient with complete atrioventricular block and right bundle branch block morphology.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Biventricular pacing can achieve cardiac resynchronization therapy (CRT) through anodal capture.
- The anodal capture effect in left bundle branch pacing (LBBP) for CRT remains unclear.
- Complete atrioventricular block with ventricular escape rhythm and right bundle branch block (RBB) morphology presents challenges for CRT.
Observation:
- A patient with complete atrioventricular block and RBB block morphology received LBBP for CRT.
- Anodal capture stimulation (ANS) during LBBP resulted in near-normal QRS morphology.
- The RBB pattern resolved due to fusion of LBBP and ANS-induced right ventricular septal capture.
Findings:
- LBBP combined with ANS can effectively achieve CRT.
- Fusion of pacing sites (LBBP and septal capture) is key to QRS normalization.
- Successful CRT via ANS is possible even without retrograde RBB activation.
Implications:
- ANS offers a potential strategy for CRT in specific patient populations.
- This finding expands the utility of LBBP for cardiac resynchronization.
- Further research is warranted to explore ANS in diverse pacing scenarios.
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