Aborted ST-elevation myocardial infarction—An unusual complication of left bundle branch pacing

Figures

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  Figure 1. A: Baseline electrocardiogram (ECG) showing complete left bundle branch block with QRS duration of 160 ms. B: ECG during anginal pain showed ST-segment elevation in leads I, aVL, and V1–V3 with reciprocal ST depression in inferior leads.

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  Figure 2. A: Right anterior oblique 30° fluoroscopy view showing the intial pacing site (right ventricular septal) superimposed on the final pacing site and its relation to the septal branch of the left anterior descending artery (LAD). LBBP = left bundle branch pacing lead; LCx = left circumflex artery; LMCA = left main coronary artery; RAA = right atrial appendage. B: Left anterior oblique 30° fluoroscopy view showing the initial and final pacing sites. RV = right ventricular.

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  Figure 3. A: Demonstration of nonselective-to-selective left bundle capture during threshold testing; note the change in QRS morphology from qR to rSR pattern along with discrete local ventricular electrogram after the pacing spike during selective capture. B: Twelve-lead electrocardiogram after left bundle branch block correction by left bundle branch pacing (LBBP) showing qR pattern in V1 with T-wave memory changes.