Peri-left bundle branch pacing in a patient with right ventricular pacing-induced cardiomyopathy and atrioventricular infra-Hisian block

Abstract

Case report A 74-years-old man who received a dual-chamber pacemaker with right ventricular (RV) septal pacing due to advanced atrioventricular (AV) block 6 years ago developed a RV pacing-induced cardiomyopathy with left ventricular ejection fraction (LVEF) of 34% and a left ventricular end-diastolic diameter (LVEDd) of 62 mm. We decided to upgrade the RV pacing to a conduction system pacing. Electrograms obtained from the pacing lead at the His-bundle revealed AV nodal disease with progressive prolongation of A-H interval with dropped His and complete infra-Hisian AV block with dissociation of His and ventricular electrograms (Figure 1A). Pacing at this site Published on behalf of the European Society of Cardiology. All rights reserved.

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing

“…In 2017, Huang et al 7 first reported left bundle branch pacing (LBBP), which is a transvenous, trans‐septal implantation technique resulting in left bundle branch (LBB) capture with low capture thresholds. Recent studies demonstrated the feasibility and effectiveness of LBBP in patients indicated for ventricular pacing and cardiac resynchronization therapy 8–10 . We previously found the LBB COI in a patient with atrial fibrillation, 11 however, there have been no systematic studies on the COI with leads implanted at the LBB.…”

The desire for physiological pacing: Are we there yet?

“…A similar study also noted that RVAp alters cellular energy metabolism and may have association with mitochondrial dynamics . A small group of patients with LV impairment and heart block showed positive gene studies in the majority with the Lamin gene being the most common abnormality . These studies suggest that RVA pacing alters myocardial dynamics at a mitochondrial level via a change in gene expression.…”

“…116 A small group of patients with LV impairment and heart block showed positive gene studies in the majority with the Lamin gene being the most common abnormality. 25 These studies suggest that RVA pacing alters myocardial dynamics at a mitochondrial level via a change in gene expression. Although it is less likely that genetic influences have major clinical relevance in the elderly, changes which alter mitochondrial function will be relevant at any age.…”

“…Although there is no internationally agreed definition, most studies have used variable criteria of deterioration in LV systolic function such as less than 50% to 45% or a >10% reduction in ejection fraction over time and/or a decrease in left ventricular end‐systolic volume more than and equal to 15%, and excluded other causes of LV impairment . The reported incidence varies with the population studied and PICM definition . Long‐term follow up data from the DANPACE study in patients with the sick sinus syndrome showed new onset heart failure occurred in 26% but, confusingly, there was no difference in the development of heart failure in either the atrial‐based pacing or dual chamber group .…”

“…23,24 The reported incidence varies with the population studied and PICM definition. [23][24][25][26] Long-term follow up data from the DANPACE study in patients with the sick sinus syndrome showed new onset heart failure occurred in 26% but, confusingly, there was no difference in the development of heart failure in either the atrial-based pacing or dual chamber group. 27 A long-term, retrospective study in children found 6 to 13% developed LV dysfunction over time whereas three separate large retrospective database analysis in adults suggested the incidence of PICM was 12.3%,14.1%, and 19.5%, respectively.…”