Key result
LBBP-based CRT-D in a mirror-image dextrocardia case shortens QRS and improves LVEF to 51%.
Why the study?
Mirror-image dextrocardia poses significant anatomical challenges to cardiac resynchronization therapy, and clinical experience with left bundle branch pacing in these patients remains extremely limited.
Case Report (n=1)
No
LBBP-CRT-D implantation is feasible and effective in patients with mirror-image dextrocardia when using preoperative mirror-image adaptation and intraoperative reverse sheath shaping.
LBBP may be feasible in mirror-image dextrocardia with HF; hypothesis-generating and requires prospective validation before practice change.
Mirror-image dextrocardia is a rare congenital malformation of visceral transposition, and its completely reversed cardiac anatomical structure poses great challenges to cardiac resynchronization therapy (CRT). Currently, clinical experience with left bundle branch pacing (LBBP) in such special patients remains extremely limited. This article reports a case of a 73-year-old male patient diagnosed with mirror-image dextrocardia complicated by advanced heart failure and complete left bundle branch block (CLBBB). Through preoperative mirror-image adaptation of electrocardiogram and digital subtraction angiography (DSA) systems, combined with reverse personalized heat shaping of the delivery sheath during the procedure, we successfully completed the implantation of an LBBP-based cardiac resynchronization therapy defibrillator (CRT-D). This case is extremely rare and provides valuable insights for the management of such patients.
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Yi et al. (2026) conducted a case report in Mirror-image dextrocardia with advanced heart failure and complete left bundle branch block (n=1). Left bundle branch pacing (LBBP) based cardiac resynchronization therapy defibrillator (CRT-D) was evaluated on Successful implantation, QRS duration, and left ventricular ejection fraction (LVEF). Left bundle branch pacing-based CRT-D implantation in a patient with mirror-image dextrocardia successfully shortened QRS duration from 171 ms to 125 ms and improved LVEF from 35% to 51% at 1 month.
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