Left bundle branch area pacing for pacing-induced cardiomyopathy in a patient with dextrocardia after ventricular septal defect closure

Figure 1. ECG and chest radiograph at the time of admission. A: ECG revealing RV pacing morphology and suspicion of an atrial standstill. B: Chest radiograph reveals cardiac dilatation (CTR 60%) without pleural effusion. Pacemaker was implanted on the left side of the chest and RV lead was implanted on the RV apical site. CTR = cardiothoracic ratio; ECG = electrocardiogram; RV = right ventricle.

Figure 2. C315 HIS catheter before and after shaping. The sheath manually shaped to bend (yellow arrow) the second curve (yellow dotted circle) in reverse to achieve an inverted RV septum with dextrocardia. RV = right ventricle.

Figure 3. Chest radiograph after LBBAP. RV lead (yellow arrow) at upper site of previous one. AP = anteroposterior; LBBAP = left bundle branch area pacing; RV = right ventricle.

Figure 4. Standard and right precordial ECG after LBBAP. In a standard ECG (left panel), the LVAT cannot be observed in the case of dextrocardia because of the Q wave in V6. In the ECG of the right precordial leads (right panel), LVAT can be evaluated using the optimal R wave in V6R. The QRS duration shortened from 217 to 116 ms after LBBAP. ECG = electrocardiogram; LBBAP = left bundle branch area pacing; LVAT = left ventricular activation time.

Figure 5. Schema of LBBAP for normal heart and dextrocardia in the axial plane. The right oval denoted the schema of LBBAP for the normal heart and the left oval for the dextrocardia. C315 His catheter (blue curve) could approach the RV septum in the normal heart; however, it would be positioned on the free wall in the dextrocardia. The sheath was manually shaped to reverse the second curve (red arrow) and could achieve an RV septum. LA = left atrium; LBBAP = left bundle branch area pacing; LV = left ventricle; RA = right atrium; RV = right ventricle.