Left Bundle Branch Area Pacing With TAVR

Figures

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  Figure 1. Electrocardiogram (A) Baseline. (B) After transcatheter aortic valve replacement with temporary pacing. (C) After left bundle branch area pacing.

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  Figure 2. Polar Plot Representations of Longitudinal Myocardial Strain Left ventricle color-coded polar maps of longitudinal myocardial strain. Left, peak-systolic longitudinal strain. Right, time-to-peak longitudinal strain. (A) The asymmetrical myocardial contraction was noted before the procedural of permanent pacemaker implantation (PPI). (B) After PPI, the asymmetrical contracting patterns were recovered.

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  Figure 3. 3D Virtual Simulation of Aortic Root Yellow dot, nadir of noncoronary cusp (NCC). Green dot, nadir of right-coronary cusp (RCC). (A) Cusp-overlap view, performed by coplanar projection overlapping RCC and left coronary cusp (LCC), and simultaneously isolating the NCC. (B) Virtual simulation of membranous septum and atrioventricular conduction axis.

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  Figure 4. Schemes of Left Bundle Branch Area Pacing Under Cusp-Overlap View (A) In cusp-overlap view, we accentuated the right noncommissure in the center of the fluoroscopic image and identified the location of membranous septum. (B) Pacing lead was screwed into the target left bundle branch area.

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  Figure 5. Final Fluoroscopy After Left Bundle Branch Area Pacing and Schemes (A) Electrocardiogram showed a qR pattern in lead V1, and a stimulus-to-peak LV activation time in V6 (LVAT) of 54 ms. (B) RAO 30°. (C) LAO 50°. AVN = atrioventricular node; LAO = left anterior oblique; LCC = left coronary cusp; NCC = noncoronary cusp; RAO = right anterior oblique; RCC = right coronary cusp.

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  Figure 6. Imaging Follow-Up After Left Bundle Branch Area Pacing (A) Cusp-overlap view in computed tomography (CT). (B) Axial view of left ventricular outflow tract (LVOT) in CT. (C) Transthoracic echocardiogram. White arrowhead, lead tip. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.