Key result
Zero-fluoroscopy LBBP guided by 3D EAM safely treats complete AV block during pregnancy.
Why the study?
LBBP offers physiological ventricular activation to prevent pacing-induced cardiomyopathy, but eliminating fluoroscopy is paramount in pregnant women to avoid fetal radiation exposure.
Is zero-fluoroscopy left bundle branch pacing using 3D electroanatomic mapping feasible and safe in a pregnant woman with complete AV block?
Is zero-fluoroscopy left bundle branch pacing using 3D electroanatomic mapping feasible and safe in a pregnant woman with complete AV block?
Zero-fluoroscopy left bundle branch pacing guided by 3D electroanatomic mapping is a feasible and safe radiation-free alternative for pregnant patients requiring pacemaker implantation.
May enable radiation-free pacing in pregnancy; leaves open need for prospective validation before wider use.
Background Left bundle branch pacing (LBBP) offers physiological ventricular activation and has been proposed as an effective pacing strategy in young patients, particularly to prevent pacing‐induced cardiomyopathy. In vulnerable populations, such as pregnant women, eliminating fluoroscopy is paramount to avoid fetal radiation exposure. Case Summary We describe a 23‐year‐old pregnant woman (20 weeks gestation) presenting with symptomatic complete atrioventricular (AV) block. A dual‐chamber pacemaker with LBBP was implanted using a three‐dimensional (3D) electroanatomic mapping (EAM) system, with complete fluoroscopy avoidance. The procedure was successful and safe, with stable pacing parameters and a favorable maternal‐fetal outcome. Conclusion This case highlights the feasibility and safety of zero‐fluoroscopy LBBP guided by 3D EAM in pregnant patients, offering a radiation‐free alternative in high‐risk scenarios.
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Morales‐Velázquez et al. (2026) studied this question. Zero-fluoroscopy left bundle branch pacing guided by 3D electroanatomic mapping was safely performed in a 23-year-old pregnant woman with complete AV block, ensuring favorable maternal-fetal outcome.
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