Key result
LBBP with anodal capture achieves near-normal QRS resynchronization despite absent retrograde right bundle branch activation.
Why the study?
Anodal capture provides a resynchronization effect in biventricular pacing, but evidence of such an effect remains unclear in left bundle branch pacing.
Does anodal capture stimulation during left bundle branch pacing improve QRS morphology in a patient with complete AV block and RBB block?
Case Report (n=1)
No
Does anodal capture stimulation during left bundle branch pacing improve QRS morphology in a patient with complete AV block and RBB block?
Anodal capture during left bundle branch pacing can achieve cardiac resynchronization by fusing LBBP and right ventricular septal capture in patients without retrograde RBB activation.
Answers are grounded in this paper and cite their sources.
Anodal capture during LBBP may enable resynchronization without retrograde RBB activation; leaves open confirmation in prospective studies.
Anodal capture can provide a resynchronization effect on biventricular pacing. However, evidence of such an effect remains unclear in left bundle branch pacing (LBBP). We report a patient with a baseline sinus rhythm with complete atrioventricular block and a ventricular escape rhythm with a right bundle branch (RBB) block QRS morphology and left axis deviation who received LBBP for cardiac resynchronization therapy (CRT), and its anodal capture stimulation (ANS) rendered a near-normal QRS morphology. The resolution of the RBB pattern during bipolar pacing in this patient resulted from a fusion of LBBP and right ventricular septal capture from ANS. In conclusion, CRT can be achieved during LBBP by ANS in patients who do not have retrograde RBB activation.
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Chokesuwattanaskul et al. (2022) conducted a case report in Complete atrioventricular block and pacing-induced left ventricular systolic dysfunction (n=1). Left bundle branch pacing with anodal capture stimulation vs. Unipolar pacing was evaluated on QRS morphology. Left bundle branch pacing with anodal capture stimulation achieved cardiac resynchronization with a near-normal QRS morphology in a patient lacking retrograde right bundle branch activation.
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