Left ventricular outflow tract obstruction following left bundle branch area pacing: a case report
Xiaoming Lian1, Xiao-Min Yang1, Rui Zhang1
1Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China.
Insights
Left bundle branch area pacing (LBBAP) can induce left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) patients. Adjusting pacing settings, like switching from bipolar to unipolar, can resolve this obstruction and improve symptoms.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiovascular Imaging
Background:
- Left bundle branch area pacing (LBBAP) is a safe pacing strategy for non-obstructive hypertrophic cardiomyopathy (HCM).
- The impact of LBBAP on left ventricular outflow tract (LVOT) obstruction in predisposed patients is not well understood.
Background:
Left bundle branch area pacing (LBBAP) is a physiological pacing strategy considered safe in non-obstructive hypertrophic cardiomyopathy (HCM). Its effect on left ventricular outflow tract (LVOT) obstruction in anatomically predisposed patients remains unclear.
Case Summary:
A 76-year-old woman underwent LBBAP for atrioventricular nodal dysfunction. One week later, she developed chest pain and elevated troponin, despite unobstructed coronaries. Echocardiography revealed a resting LVOT gradient of 112.6 mmHg. Bipolar low-voltage pacing worsened the gradient, while unipolar high-voltage pacing reduced it to 15 mmHg, with symptom relief and improved global longitudinal strain.
Discussion:
This case illustrates a rare interaction between pacing configuration and LVOT dynamics. It emphasizes the need to recognize pacing-induced obstruction, particularly in patients with septal hypertrophy or mitral anomalies, and to adjust programming accordingly.
Related Concept Videos
Cardiac Catheterization III: Left Heart Catheterization
Data Reporting and Recording
Types of Reports I: Hands-off Report
Following are the key components and categories of hand-off reports:
Purpose and Process:
Types of Reports II: Incident or Occurrence Report
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...
Mass Spectrometry: Branched Alkane Fragmentation
Generation of Straight or Branched Actin Filaments
Arp2/3 Complex
Arp2/3 complex is a seven-subunit complex consisting of two proteins similar to actin- Arp2 and Arp3, and five other subunits that help keep Arp2 and Arp3 inactive. When required, the complex is...


