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Zero-Fluoroscopy Left Bundle Branch Pacing in Pregnancy Using Electroanatomic Mapping
Jose Luis Morales-Velázquez1, Erick Sánchez-Rodriguez1, Hugo Enrique Coutiño-Moreno1
1Department of Cardiac Electrophysiology, Hospital De Cardiología, Centro Medico Nacional Siglo XXI, IMSS, México City, México.
Background:
Left bundle branch pacing (LBBP) offers physiological ventricular activation and has been proposed as an effective pacing strategy in young patients, particularly to prevent pacing-induced cardiomyopathy. In vulnerable populations, such as pregnant women, eliminating fluoroscopy is paramount to avoid fetal radiation exposure.
Case Summary:
We describe a 23-year-old pregnant woman (20 weeks gestation) presenting with symptomatic complete atrioventricular (AV) block. A dual-chamber pacemaker with LBBP was implanted using a three-dimensional (3D) electroanatomic mapping (EAM) system, with complete fluoroscopy avoidance. The procedure was successful and safe, with stable pacing parameters and a favorable maternal-fetal outcome.
Conclusion:
This case highlights the feasibility and safety of zero-fluoroscopy LBBP guided by 3D EAM in pregnant patients, offering a radiation-free alternative in high-risk scenarios.
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