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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Unmasking Type 1 Brugada Pattern During Ajmaline Challenge Despite Left Bundle Branch Pacing.

Paolo Pastori¹, Cristina Balla², Francesco Vitali²

¹Cardiology Unit, Fidenza Hospital, Azienda USL of Parma, Fidenza, Italy.

JACC. Case Reports

|June 25, 2026

Summary

This study shows Brugada pattern is detectable even with left bundle branch pacing. Conduction system pacing does not obscure these crucial repolarization abnormalities.

Keywords:

Brugada syndrome ajmaline electrocardiography left bundle branch pacing sodium-channel blocker test

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Area of Science:

Cardiology
Electrophysiology
Medical Devices

Background:

Brugada pattern is an electrocardiographic finding associated with increased risk of sudden cardiac death.
Left bundle branch pacing (LBBP) is an alternative pacing method for heart block.
Altered ventricular activation during pacing can affect electrocardiogram interpretation.

Purpose of the Study:

To investigate the detectability of Brugada pattern during LBBP.
To assess the impact of conduction system pacing on Brugada repolarization abnormalities.

Main Methods:

A patient with syncope, right bundle branch block, and infra-Hisian atrioventricular block underwent LBBP.
An ajmaline challenge was performed post-device implantation with high-precordial lead positioning.
Electrocardiograms were analyzed during intrinsic rhythm and LBBP.

Main Results:

A diagnostic type 1 Brugada pattern was unmasked by ajmaline challenge.
The Brugada pattern was evident during both intrinsic beats and LBBP-paced beats.
High-precordial lead positioning facilitated Brugada pattern recognition.

Conclusions:

Diagnostic Brugada repolarization abnormalities can be recognized despite altered ventricular activation from LBBP.
Conduction system pacing does not necessarily mask Brugada syndrome.
Careful ECG interpretation and provocative testing remain vital in patients with suspected Brugada syndrome undergoing pacing.