Left bundle branch area pacing successfully normalized conduction and maintained stable pacing and sensing thresholds (0.75/0.4 ms and 14 mV) at 3-month follow-up in a patient with 2:1 AV block.
Case Report (n=1)
Left bundle branch area pacing successfully restored normal conduction and resolved symptoms in a patient with 2:1 AV block and LBBB where His-bundle pacing had unacceptably high thresholds.
INTRODUCTION: Recent studies have shown that His-bundle pacing could be an alternative in patients requiring cardiac resynchronization therapy as it is comparable or better in terms of amelioration of ventricular activation, narrowing of the QRS complex, or clinical outcomes. However, in case of high threshold at the level of His-bundle or inability to correct conduction through a diseased His-Purkinje system other option should be searched like left bundle pacing. PATIENT CONCERNS: A 77-year-old man presented to the Emergency Department for dizziness and dizziness and lightheadedness due to an intermittent 2:1 atrioventricular block with a QRS complex morphology of a major left branch block. DIAGNOSIS: Given the documented symptomatic 2:1 AV block, according to the European Guideliness the patient was considered to have a class 1 indication of permanent double chamber cardiostimulation. INTERVENTIONS: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead were placed at the His bundle area with important narrowing of the QRS complex but with an unacceptable high threshold. The delivery system was moved towards the apex 1,5 cm and the lead screwed deep into the septum until capture of the left bundle branch was achieved with complete normalization of the conduction troubles. OUTCOMES: At 3 month follow-up the patient was asymptomatic and the pacing and sensing thresholds remained at same values as during implantation: 0.75/0.4 ms and 14 mV respectively. CONCLUSION: Left bundle-pacing represents the next step of His-Purkinje system pacing to overcome all difficulties related to His-bundle pacing.
Pestrea et al. (2020) conducted a case report in Intermittent 2:1 atrioventricular block with left bundle branch block (n=1). Left bundle branch area pacing was evaluated on Pacing and sensing thresholds and clinical symptoms. Left bundle branch area pacing successfully normalized conduction and maintained stable pacing and sensing thresholds (0.75/0.4 ms and 14 mV) at 3-month follow-up in a patient with 2:1 AV block.