Transhepatic Left Bundle Branch Area Pacing in a Patient With Ebstein Anomaly and Prior Glenn Surgery: A First Report
Werner Schlie Villa1, José Luis Rico Rico1, Jesús Antonio Vera Hernández2
1Department of Cardiac Electrophysiology, Cardiology Hospital, National Medical Center "Siglo XXI", Mexico, CDMX, Mexico.
Background:
Venous access exhaustion poses a significant challenge for the implantation of intracardiac devices. Epicardial alternatives are often used in these cases, despite their long-term deleterious effects. This case presents a transhepatic approach for left bundle branch pacing in a patient with Ebstein anomaly and a prior Glenn procedure.
Methods:
Following pre-procedural evaluation with triphasic CT, ultrasound-guided hepatic vein puncture was performed. Guidewires were advanced into the right heart chambers, allowing passage of a delivery sheath for physiologic pacing. Atrial lead placement followed.
Results:
Appropriate electrical parameters were achieved for both atrial and ventricular leads, with effective biventricular resynchronization via selective left bundle branch pacing.
Conclusion:
The transhepatic approach is a viable alternative when conventional venous access is not available. Although previously described for traditional pacing systems, this report documents the feasibility of left bundle branch pacing for cardiac resynchronization via the transhepatic route.
