Left Bundle Branch Area Pacing from the Functional Right Ventricle in Ebstein's Anomaly with Atrioventricular Block

Figures

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  Figure 1. Surface electrocardiograms and echocardiographic findings. A: Electrocardiogram on admission showing a normal PR interval without bundle branch block. B: Electrocardiogram after left bundle branch area pacing. C: Echocardiography on admission showing apical displacement of the TV septal leaflet 28 mm from the MV attachment. D: Doppler imaging revealed severe tricuspid regurgitation with a peak gradient of 40 mm Hg. E: Echocardiography after implantation showing the pacing lead positioned apically beyond the septal leaflet of the TV. F: Doppler imaging after implantation showed no worsening of regurgitation, with a peak gradient of 34 mm Hg. MV = mitral valve; TV = tricuspid valve.

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  Figure 2. Right atriography and lead positions. A: Right atriography in the right anterior oblique view showing displacement of the TV septal leaflet (arrowheads), dividing the right ventricle into the atrialized (ARV) and functional (FRV) portions. The corresponding right atriography video is provided in Supplemental Video 1. B: Lead position after pacemaker implantation with left bundle branch area pacing. ARV = atrialized right ventricle; FRV = functional right ventricle; RA = right atrium; TV = tricuspid valve.