Key result
High-density electroanatomic mapping-guided corrective His bundle pacing successfully restored physiological conduction and led to clinical improvement in a patient with persistent left superior vena cava.
Why the study?
Transvenous device implantation for CRT can be challenging in patients with persistent left superior vena cava.
Case Report (n=1)
EAM-guided corrective His bundle pacing may be a feasible alternative to conventional CRT in patients with unfavorable venous anatomy such as persistent left superior vena cava.
Supports feasibility in persistent left superior vena cava; leaves open generalizability pending prospective data.
In patients with persistent left superior vena cava (PLSVC), transvenous device implantation for cardiac resynchronization therapy (CRT) may be challenging. We present a complex case with successful, high-density electroanatomic mapping (EAM) guided corrective His bundle pacing (CHBP) following failed CRT upgrade in a patient with PLSVC, congenital heart disease, and pacing-associated heart failure. CHBP restored physiological conduction in left bundle branch block with complete conduction block leading to clinical improvement and cardiac remodeling. The presented case supports the growing evidence that EAM-guided CHBP may be considered a feasible alternative to conventional CRT when venous anatomy is not favorable for left ventricular lead implantation.
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Bastian et al. (2020) conducted a case report in Persistent left superior vena cava, congenital heart disease, and pacing-associated heart failure (n=1). High-density electroanatomic mapping (EAM) guided corrective His bundle pacing (CHBP) was evaluated on Restoration of physiological conduction, clinical improvement, and cardiac remodeling. High-density electroanatomic mapping-guided corrective His bundle pacing successfully restored physiological conduction and led to clinical improvement in a patient with persistent left superior vena cava.
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