Left-bundle branch pacing as bail-out strategy after failed coronary sinus lead placement for cardiac

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Updated: Oct 2, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

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

Published on: December 11, 2017

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Thomas Fink1, Thomas Eitz2, Christian Sohns1

  • 1Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany.

European Heart Journal. Case Reports
|September 30, 2022
PubMed

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.
Abstract

Keywords:
Case reportConduction system pacingFailed cardiac resynchronization therapyHeart failureLeft-bundle branch pacing

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