Key result
Left-bundle branch pacing successfully achieved cardiac resynchronization as a bail-out therapy after failed coronary sinus lead implantation and ineffective His-bundle pacing.
Why the study?
ESC guidelines recommend conduction system pacing as a potential bail-out therapy when CS-lead implantation fails, but clinical experience with LBBP after failed CS lead and ineffective HBP warrants description.
Does left-bundle branch pacing improve electrocardiographic and echocardiographic parameters of cardiac resynchronization in a patient with failed coronary sinus lead placement and ineffective His-bundle pacing?
Case Report (n=1)
Does left-bundle branch pacing improve electrocardiographic and echocardiographic parameters of cardiac resynchronization in a patient with failed coronary sinus lead placement and ineffective His-bundle pacing?
Left-bundle branch pacing can serve as an effective bail-out strategy for cardiac resynchronization therapy when coronary sinus lead placement fails and His-bundle pacing is ineffective.
LBBP may serve as bail-out for CRT after CS/HBP failure; leaves open need for prospective trials.
Background: Cardiac resynchronization therapy (CRT) by implantation of an endocardial coronary sinus (CS) pacing lead is an established heart failure therapy. The recent European Society of Cardiology (ESC) guidelines on cardiac pacing and CRT recommend conduction system pacing (CSP) as a potential bail-out therapy in patients with previously unsuccessful CS-lead implantation. We present a case in which unsuccessful implantation of a CS pacing and ineffective QRS correction by His-bundle pacing (HBP) was overcome by left-bundle branch pacing (LBBP) to achieve cardiac resynchronization. Case summary: The patient had to undergo revision of a CS lead for CRT due to rising pacing thresholds and pacing impedance. CS-lead implantation was omitted by a stenotic posterolateral CS branch. HBP did not lead to adequate QRS correction. The patient underwent successful LBB lead implantation as bail-out therapy. After LBBP lead implantation electrocardiographic and echocardiographic parameters were evident of effective CRT. Discussion: Conduction system pacing may be an alternative to CS pacing for CRT in heart failure patients, which is endorsed by the current European guidelines. LBBP may overcome limitations of HBP and provide an alternative to other strategies such as surgical implantation of epicardial left-ventricular pacing leads. Further studies are needed to fully clarify the role of LBBP for heart failure treatment.
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Fink et al. (2022) conducted a case report in Heart failure requiring cardiac resynchronization therapy (n=1). Left-bundle branch pacing (LBBP) vs. His-bundle pacing (HBP) / Coronary sinus (CS) pacing was evaluated on Cardiac resynchronization (electrocardiographic and echocardiographic parameters). Left-bundle branch pacing successfully achieved cardiac resynchronization as a bail-out therapy after failed coronary sinus lead implantation and ineffective His-bundle pacing.
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