Left Bundle Branch Area Pacing with a Defibrillator Lead in a Patient with Recurrent Ventricular Tachycardia and Severe Nonischemic Cardiomyopathy: A Case Report.

Figure 1:. A: Baseline electrocardiogram. B, C: Ventricular tachycardia.

Figure 2:. A: Basic architecture of Reliance 4-Front implantable cardioverter-defibrillator lead.9 Reliance 4-Front lead with extended helix9 (B) and EZ-4 connector (C).9 Abbreviations: DFT, defibrillation testing; ETFE, ethylene tetrafluoroethylene; PTFE, polytetrafluoroethylene.

Figure 3:. Left anterior oblique A: and right anterior oblique B: views of the final lead position.

Figure 4:. Left bundle branch area pacing parameters. A: Intracardiac electrocardiogram showing baseline QRS duration of 113 ms. B: At high-output (5V) unipolar pacing, the left ventricular activation time (LVAT) was 78 ms, as shown in the figure; at a lower output (1V), there was the appearance of an Rsr’ pattern in V1, though the LVAT remained same, suggesting non-selective to selective left bundle branch capture..

Figure 5:. A: Post-procedure chest X-ray showing lead positions. B: Post-procedure electrocardiogram.