Permanent nonselective His bundle pacing in an adult with L‐transposition of the great arteries and complete AV block

Abstract

We report the placement of a permanent transvenous nonselective His bundle pacing lead in conjunction with a transvenous pacemaker/implantable cardioverter-defibrillator in an adult with Levo-Transposition of the Great Arteries (L-TGA) and a stenotic coronary sinus (CS) ostium, which would not accommodate a transvenous left ventricular (LV) pacing lead. Nonselective His bundle pacing provided a nearly identical ventricular activation pattern in this previously unpaced patient. Many L-TGA patients will have an eventual need for permanent pacing and, given the challenges of CS cannulation, His bundle pacing may represent a preferred modality rather than pure morphologic LV pacing or surgical systemic ventricular lead placement to achieve optimal electrical synchrony.

Permanent His-bundle Pacing in Pediatrics and Congenital Heart Disease

“…The AV node in these patients may be displaced in certain lesions, while transvenous access to the coronary sinus may not be possible for biventricular pacing. The successful implantation of a His-bundle pacemaker has been described before in an adult patient with L-transposition of the great arteries (LTGA) and complete AV block 39 (Figures 5A and 5B). This type of pacing was an attractive option, given the difficulty in cannulating the coronary sinus for CRT.…”

Successful staged tricuspid valve replacement following cardiac resynchronization therapy in a congenitally corrected transposition of the great arteries

“…High prevalence of coronary venous anomalies, such as separate CS ostia, dual CS ostia, and a vein of Marshall without CS ostia in ccTGA, was reported ; therefore, a review of coronary venous drainage using the levophase of a coronary angiography or CT scan before CS cannulation and coronary venography after CS cannulation is important. His‐bundle pacing is an alternative treatment, especially for difficult cases of CS cannulation owing to an abnormal coronary vein and CS ostium in ccTGA . In ccTGA, atrioventricular conduction is usually anteriorly deviated; therefore, selective His‐bundle pacing using an ICD lead or even a pacing lead instead of a CS lead seems to be technically difficult and still challenging .…”

“…7 In ccTGA, atrioventricular conduction is usually anteriorly deviated; therefore, selective His-bundle pacing using an ICD lead or even a pacing lead instead of a CS lead seems to be technically difficult and still challenging. 7 Because this case showed a usual CS ostium on the CT scan, we chose conventional CRT for this case. We could safely administer the beta-blocker, amiodarone, and ACE inhibitor owing to reverse tissue and electrical sRV remodeling after CRT-D implantation.…”

“…His‐bundle pacing is an alternative treatment, especially for difficult cases of CS cannulation owing to an abnormal coronary vein and CS ostium in ccTGA . In ccTGA, atrioventricular conduction is usually anteriorly deviated; therefore, selective His‐bundle pacing using an ICD lead or even a pacing lead instead of a CS lead seems to be technically difficult and still challenging . Because this case showed a usual CS ostium on the CT scan, we chose conventional CRT for this case.…”

Direct His bundle pacing using retrograde mapping in complete heart block and L-transposition of the great arteries

“…Interestingly, dual AV nodes and bundles of His have been noted in some patients with L-TGA. In patients with the usual perimembranous, subpulmonary ventricular septal defect, the bundle of His passes along the anterior and superior rim of the defect in a markedly different location than in hearts with normal anatomy 4, 9. We recorded a retrograde His bundle potential first from a decapolar His recording catheter and then from the lead, with resultant successful selective His capture, significant QRS narrowing, and an excellent clinical response.…”