Case report: What course to follow when left bundle branch pacing encounters acute myocardial infarction?

Abstract

Compared with traditional right ventricular apical pacing, His-bundle pacing (HBP) provides more physiologic pacing by activating the normal conduction system. However, HBP has some limitations including higher pacing thresholds. In addition, disease in the distal His-Purkinje system may prevent the correction of abnormal conduction. Left bundle branch pacing (LBBP) may overcome these disadvantages by providing lower pacing thresholds and relatively narrow QRS duration that improve cardiac function. Here, we describe a rare case of a transient loss of ventricular capture due to acute anterior wall myocardial infarction in an LBB-paced patient. With the improvement of the ischemia, the function of the pacemaker partly recovered. We review the adaptations, advantages, and limitations, and long-term safety of LBBP.

Feasibility and safety of left bundle branch area pacing for patients with stable coronary artery disease

“…Additionally, our research found that stable CAD patients had similar pacing thresholds, R wave amplitudes, and impedances compared to non-CAD patients during the procedure and at the 6-month and 12-month follow-up visits. Previous studies have presented divergent accounts concerning the impact of myocardial ischemia on pacing parameters ( 20 , 35 – 37 ). Considering that, our study population included patients who underwent pacemaker implantation and CAG during the same hospitalization period.…”

“…Coronary artery disease (CAD) is acknowledged globally as one of the foremost causes of disease burden, affecting millions of individuals worldwide ( 18 ). As a prevalent comorbidity among patients with pacemaker implantation, CAD might exert an influence on the safety and prognosis of patients with permanent pacemaker implantation ( 19 , 20 ). Considering that the majority of CAD patients undergoing coronary angiography (CAG) and pacemaker implantation during the same hospitalization are in a stable condition, investigating the impact of stable CAD on pacemaker implantation patients has potentially important clinical implications.…”

“…While LBBaP has attracted significant attention in recent years due to its stable pacing parameters and the improvement of left ventricular mechanical function, severe myocardial ischemia may impact pacing parameters and prognosis ( 20 ). Moreover, the inevitable transseptal lead fixation may increase the risks of implantation complications.…”