Successful termination of ventricular tachycardia by intrinsic antitachycardia pacing delivered from a left bundle branch area pacing lead: a case report

Figures

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  Successful intrinsic antitachycardia pacing from left bundle branch area pacing lead. White arrowhead: left bundle branch area pacing lead. LOT-CRTD, left bundle branch area pacing–optimized cardiac resynchronization therapy with defibrillator.

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  Figure 1. (A) 12-lead electrocardiogram after removal of Impella CP. Sinus rhythm, QRS duration 106 ms with abnormal Q wave in II, III, aVF. (B) 12-lead electrocardiogram demonstrating VT, HR 107 beats/min, QRS duration 156 ms. Electroanatomical mapping identified the VT origin at the septal aspect of the left ventricular apex, and radiofrequency ablation was successfully performed. (C) Iatrogenic left bundle branch block pattern on the 12-lead electrocardiogram. Sinus rhythm, QRS duration 196 ms.

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  Figure 2. (A) LOT-CRTD system (white arrowhead: LBBAP lead). (B) Intra-procedural electrocardiogram showing the evidence of LBB capture. (C) 12-lead electrocardiogram demonstrating biventricular pacing with paced QRS duration of 124 ms.

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  Figure 3. Intracardiac electrogram (EGM) of ventricular tachycardia (VT). (A) Intrinsic antitachycardia pacing (iATP) successfully terminates VT1 (CL: 400 ms) in the first sequence. (B) iATP failed to terminate VT2 (CL: 410 ms) in the first sequence. However, based on the post-pacing interval, the second sequence varied the series of the pulse of iATP and terminated VT2 in the second sequence. (C) iATP failed to terminate VT3 (CL: 450 ms) in the first and second sequences. The third sequence terminated.