Key result
Left bundle pacing combined with AVN ablation resulted in a new-onset intrinsic and paced RBBB pattern that could not be corrected, suggesting anatomical separation.
Case Report (n=1)
No
The observation of an uncorrectable paced RBBB pattern after AVN ablation during left bundle pacing suggests anatomical separation of the bundle branches rather than longitudinal dissociation.
Indicates anatomical separation of bundle branches; hypothesis-generating case report requiring prospective validation.
We performed left bundle pacing combined with atrioventricular nodal (AVN) ablation in a patient with persistent atrial fibrillation and refractory symptomatic heart failure. The major findings were new-onset intrinsic and paced QRS morphology of right bundle branch block (RBBB) pattern after AVN ablation which was performed at a more atrial site compared with the pacing site and the paced RBBB pattern could not be corrected regardless of the pacing output. Longitudinal dissociation cannot explain this observation, while anatomical separation could. We also confirm this was proximal left bundle pacing rather than His bundle pacing.
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Wu et al. (2020) conducted a case report in Persistent atrial fibrillation and refractory symptomatic heart failure (n=1). Left bundle pacing combined with atrioventricular nodal (AVN) ablation was evaluated on QRS morphology. Left bundle pacing combined with AVN ablation resulted in a new-onset intrinsic and paced RBBB pattern that could not be corrected, suggesting anatomical separation.
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