Right subclavian vein approach for selective left bundle branch pacing: A case report

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Symptomatic bradycardia due to chronic atrial fibrillation necessitates pacemaker implantation.
• Left bundle branch pacing (LBBP) is an alternative pacing strategy.
• The right subclavian vein (RSV) approach offers a potential route for device implantation.

Observation:

• A 65-year-old male patient with symptomatic bradycardia underwent LBBP via the RSV approach.
• Tricuspid valve annulus (TVA) angiography was utilized to identify the optimal pacing site.
• A novel connecting cable enabling real-time electrocardiogram (ECG) and intracardiac electrogram (EGM) monitoring was employed.

Findings:

• TVA angiography facilitated accurate localization for LBBP lead placement.
• The new monitoring cable aided in avoiding perforation and ensuring effective pacing thresholds.
• The combined technique proved feasible and safe for LBBP through the RSV route.

Implications:

• This approach offers a potentially safer and more efficient method for LBBP implantation.
• The use of TVA angiography and advanced monitoring cables may improve procedural success rates.
• This technique could expand the applicability of LBBP in managing bradyarrhythmias.