A clinical case of the left bundle branch area stimulation in a patient with initial apical right ventricular pacing

Pacemaker implantation is the primary treatment for bradyarrhythmias such as atrioventricular and sinoatrial block. Currently, it is a routine practice to implant a pacemaker’s electrode into the apex of the right ventricle. However, a number of studies performed in recent years have shown the negative consequences of chronic right ventricular pacing. Electrical and mechanical dissynchrony, leading to abnormal ventricular contraction, leads to remodeling of the left ventricular myocardium, which in turn causes the appearance and progression of heart failure symptoms, the occurrence of atrial arrhythmias, and increased mortality from cardiovascular causes. Pacing of the heart’s conduction system is a promising direction in the treatment of bradyarrhythmias, causing a more physiological response to stimulation through the His-Purkinje system. Material and methods. This article presents a clinical case of changing the area of permanent cardiac pacing in a patient with complete atrioventricular block, previously corrected with a pacemaker. Results. The patient underwent surgery, which consisted of replacing the pacemaker with a change in the ventricular stimulation area. As a result of the transition from apical stimulation to stimulation of the left bundle branch of the His bundle, the patient’s well-being improved: exercise tolerance and quality of life increased, and some myocardial dyssynchrony indicators changed.