Left Bundle Branch Area Pacing to Overcome Coronary Sinus Anatomy-Related Technical Problems Encountered during
Jędrzej Michalik1, Roman Moroz1, Marek Szołkiewicz1
1Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland.
Insights
Left bundle branch area pacing offers an effective alternative for patients ineligible for traditional cardiac resynchronization therapy (CRT). This approach ensures successful cardiac resynchronization when standard biventricular pacing fails due to anatomical challenges.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB).
- Up to one-third of eligible patients do not benefit from biventricular pacing due to lead placement issues.
- A challenging coronary sinus anatomy can preclude standard CRT lead implantation.
Observation:
- A case report details a patient with HFrEF and LBBB who could not receive standard biventricular CRT.
- The patient presented with a difficult coronary sinus anatomy, preventing conventional lead placement.
- Left bundle branch area pacing (LBBAP) was successfully implemented as an alternative pacing strategy.
Findings:
- LBBAP achieved effective electrical and mechanical cardiac resynchronization in the patient.
- This demonstrates the feasibility and efficacy of LBBAP in challenging anatomies.
- Successful resynchronization was confirmed through appropriate pacing parameters and clinical improvement.
Implications:
- Left bundle branch area pacing presents a viable alternative for patients unresponsive to or ineligible for standard CRT.
- This technique expands treatment options for heart failure patients with specific pacing lead placement difficulties.
- Further research into LBBAP could optimize heart failure management and improve patient outcomes.
Abstract:
The results of clinical trials show that up to one-third of patients who are eligible for cardiac resynchronization therapy (CRT) do not benefit from biventricular pacing. The reasons vary, including technical problems related to left ventricle pacing lead placement in the appropriate branch of the coronary sinus. Herein, we present a case report of a patient with heart failure with reduced ejection fraction and left bundle branch block, in whom a poor coronary sinus bed made implantation of classic biventricular CRT impossible, but in whom, alternatively, rescue-performed left bundle branch area pacing allowed effective electrical and mechanical cardiac resynchronization. The report confirms that left bundle branch area pacing may be a rational alternative in such cases.
