Left-bundle branch pacing as bail-out strategy after failed coronary sinus lead placement for cardiac
Thomas Fink1, Thomas Eitz2, Christian Sohns1
1Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany.
Insights
Left-bundle branch pacing (LBBP) offers an effective alternative for cardiac resynchronization therapy (CRT) when coronary sinus (CS) lead implantation fails. This approach successfully achieved CRT in a patient unresponsive to His-bundle pacing (HBP).
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Established cardiac resynchronization therapy (CRT) utilizes coronary sinus (CS) pacing leads.
- European Society of Cardiology guidelines suggest conduction system pacing (CSP) as a backup for failed CS lead implantation.
- Left-bundle branch pacing (LBBP) is explored as an alternative to CS pacing for CRT.
Observation:
- A patient required revision of a CS lead for CRT due to high pacing thresholds and impedance.
- CS lead implantation was unsuccessful due to a stenotic CS branch.
- His-bundle pacing (HBP) failed to adequately correct QRS duration.
Findings:
- Successful LBBP lead implantation was achieved as a bail-out therapy.
- Post-LBBP implantation, electrocardiographic and echocardiographic parameters demonstrated effective CRT.
- LBBP successfully overcame limitations encountered with HBP.
Implications:
- LBBP presents a viable alternative to CS pacing for CRT in heart failure patients.
- LBBP may circumvent challenges associated with HBP and epicardial lead implantation.
- Further research is necessary to fully establish the role of LBBP in heart failure treatment.
Background:
Cardiac resynchronization therapy (CRT) by implantation of an endocardial coronary sinus (CS) pacing lead is an established heart failure therapy. The recent European Society of Cardiology (ESC) guidelines on cardiac pacing and CRT recommend conduction system pacing (CSP) as a potential bail-out therapy in patients with previously unsuccessful CS-lead implantation. We present a case in which unsuccessful implantation of a CS pacing and ineffective QRS correction by His-bundle pacing (HBP) was overcome by left-bundle branch pacing (LBBP) to achieve cardiac resynchronization.
Case Summary:
The patient had to undergo revision of a CS lead for CRT due to rising pacing thresholds and pacing impedance. CS-lead implantation was omitted by a stenotic posterolateral CS branch. HBP did not lead to adequate QRS correction. The patient underwent successful LBB lead implantation as bail-out therapy. After LBBP lead implantation electrocardiographic and echocardiographic parameters were evident of effective CRT.
Discussion:
Conduction system pacing may be an alternative to CS pacing for CRT in heart failure patients, which is endorsed by the current European guidelines. LBBP may overcome limitations of HBP and provide an alternative to other strategies such as surgical implantation of epicardial left-ventricular pacing leads. Further studies are needed to fully clarify the role of LBBP for heart failure treatment.
