Left Bundle Branch Pacing in a Patient With Dextroposed Heart: A Case Report

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• The right ventricular (RV) apex is the conventional site for pacing in symptomatic bradyarrhythmias.
• Chronic RV pacing is associated with adverse outcomes, including atrial arrhythmias and left ventricular dysfunction.
• Physiological pacing strategies, such as His bundle and left bundle pacing, aim to mitigate these complications.

Purpose of the Study:

• To evaluate the feasibility and efficacy of left bundle branch pacing (LBBP) in a patient with complex cardiac anatomy and a high RV pacing burden.
• To present a case demonstrating modified lead placement and access techniques for LBBP in challenging anatomical conditions.

Main Methods:

• The study involved a 66-year-old male with a dextroposed heart and fibrotic right lung.
• Left bundle branch pacing was performed using a modified lead placement technique.
• Vascular access was achieved via a medial subclavian vein puncture.

Main Results:

• Successful implantation of the left bundle branch pacing system was achieved.
• Good electrical parameters were obtained post-procedure.
• The patient demonstrated successful post-procedural device function.

Conclusions:

• Left bundle branch pacing is a feasible and effective alternative pacing strategy in patients with complex cardiac anatomies.
• Modified techniques can overcome anatomical challenges for successful LBBP implantation.
• LBBP may offer a more physiological approach to pacing, potentially reducing long-term complications associated with RV pacing.