Corrección del bloqueo de rama derecha inducido iatrogénicamente mediante estimulación del área de la rama izquierda del haz

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Updated: Jan 8, 2026

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

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

Published on: December 11, 2017

Hironobu Sumiyoshi¹, Akira Mizukami², Takumi Arashiro³

¹Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan.

JACC. Case reports

|December 12, 2025

Abstracto

Background:

Correction of right bundle branch block (RBBB) by left bundle branch area pacing (LBBAP) has traditionally been attributed to capture within a longitudinally dissociated His bundle. Based on this theory, conduction block in the distal right bundle would not be expected to resolve.

Case Summary:

We describe a 90-year-old man with cardiac amyloidosis who underwent pacemaker implantation. During the procedure, advancement of the delivery catheter toward the right ventricular septum induced iatrogenic complete RBBB. Remarkably, pacing from this site corrected the block. The lead was then advanced >2 cm intraseptally, achieving successful LBBAP. Postoperatively, intrinsic conduction remained as RBBB, but unipolar pacing consistently corrected it.

Discussion:

Correction of an iatrogenic RBBB by LBBAP suggests the involvement of a septal intramyocardial conduction network as a potential mechanism.

Take-Home Message:

RBBB due to a lesion distal to the His bundle may be correctable with LBBAP.

Palabras clave:

amiloidosis cardíaca estimulación del sistema de conducción estimulación del área de la rama izquierda del haz disociación longitudinal bloqueo de rama derecha

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