Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block

Yang

Front. Cardiovasc. Med.

et al. 2022

Atrial standstill (AS) is a rare condition defined by the lack of atrial electrical and mechanical activities. It is usually clinically manifested as symptomatic bradycardia, which requires permanent pacemaker (PPM) implantation. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, heart failure, and arrhythmias. As a novel physiological pacing strategy, left bundle branch area pacing (LBBaP) has demonstrated effectiveness and safety in recent years, but its application in exceptional conditions is rarely reported. We report the case of a 47-year-old female, who was diagnosed with AS complicated with a giant atrium, and successfully received a single-chamber PPM with LBBaP.

Section: Discussionmentioning

confidence: 99%

Left Bundle Branch Area Pacing in a Giant Atrium With Atrial Standstill: A Case Report and Literature Review

Yang

Front. Cardiovasc. Med.

et al. 2022

“…It remains unclear whether LBBP was the best choice to avoid further deterioration of cardiac function or whether the patient should receive an ICD to prevent sudden cardiac death. Recent studies have shown that upgrading to LBBP can effectively improve heart function and quality of life in patients with pacing-induced cardiomyopathy[ 3 - 5 ]. However, LBBP in patients with cardiac dysfunction and high-degree AVB lacks evidence.…”

Section: Discussionmentioning

confidence: 99%

“…It is appropriate for pacing-dependent patients to prevent left ventricular mechanical asynchrony and to reduce the morbidity of heart dysfunction. A previous clinical study has already shown that LBBP is superior for maintaining physiological ventricular activation[ 2 ] and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy[ 3 - 5 ]. However, LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well evaluated.…”

Section: Introductionmentioning

confidence: 99%

Left bundle branch pacing in a ventricular pacing dependent patient with heart failure: A case report

Song¹,

Wang²,

An³

et al. 2022

WJCC

BACKGROUND Left bundle branch pacing (LBBP) is a physiological pacing method that has emerged in recent years. It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy (CRT). Moreover, LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy. However, LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed. CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness, palpitation and systolic heart failure with New York Heart Association class III for 1 mo. The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat. Holter revealed a right bundle branch block, atrial fibrillation with third-degree atrioventricular block, frequent multifocal ventricular premature beats, Ron-T and ventricular tachycardia. The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction. Coronary angiography indicated a stenosis of 30% in the middle left anterior descending artery. Apparently, a CRT-D pacemaker was the best choice for this patient according to previous findings. However, the patient was worried about the financial burden. A single-chamber pacemaker with LBBP was selected, with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time. During the follow-up at 3 mo after LBBP, the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters, and the New York Heart Association functional class was maintained at I. Moreover, the patient no longer suffered from chest tightness and palpitation. Holter showed decreased ventricular arrhythmia of less than 5%. CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.

“…LBBP is a novel pacing strategy with a low and stable threshold firstly reported by Huang et al ( 9 ), which overcomes the limitation of HBP. In infranodal block, LBBP can pace distal to the site of the block with a high success rate and favorable clinical findings ( 10 ). Previous studies showed LBBP could improve clinical outcomes in heart failure patients with LBBB ( 5 , 11 ) and achieve similar improvements in LV function comparable with HBP in patients with CRT indications ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Interventricular Septal Hematoma Complicating Left Bundle Branch Pacing Lead Implantation

Front. Cardiovasc. Med.

Wang

et al. 2021

Self Cite

Background: Left bundle branch pacing (LBBP) is a novel physiological pacing and previous studies have confirmed the feasibility and safety of it. The incidence of complications in LBBP is relatively low as reported. Here we present a case of interventricular septal hematoma complicating LBBP lead implantation.Case summary: LBBP was achieved for treatment of high-grade atrioventricular block in a 67-year-old female. Chest pain began 1 h after implantation when the electrocardiogram showed ST-T changes. Then bedside echocardiography confirmed the formation of interventricular septal hematoma. Urgent coronary angiography showed the contrast agent retention and overflow in the interventricular septum. The symptom was relieved half an hour later. Echocardiogram performed 2 h later revealed the size of the hematoma was the same as before. The electrocardiography, coronary angiography and CTA confirmed the resolution of the hematoma at 1-month follow-up. Pacing parameters and cardiac function remained stable during 6-month follow-up.Conclusion: This is the first reported case describing the clinic features and management of interventricular septum hematoma complicating LBBP. The importance of routine echocardiograms after implantation for identifying the hematoma should be highlighted.