Case report shows successful left bundle branch area pacing in a patient with right atrial enlargement and tricuspid annuloplasty, suggesting a new approach for challenging cases.
We report a successful LBBAP lead implantation using the sheath-in-sheath technique in a patient with RA enlargement and a TAP ring. The sheath-in-sheath technique can serve as a valuable alternative approach in patients with structural heart abnormalities in whom LBBAP lead placement with a standard delivery system is technically challenging.
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Kato et al. (2025) studied this question.
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