Left bundle branch area pacing with stylet driven lead in third-degree atrioventricular block following Morrow surgery

Figures

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  Figure 1. Electrocardiograph modification during unipolar pacing indicative of left bundle branch capture. A: Sharp reduction of QRS duration (185 vs 135 ms). B: R’ appearance in lead V1 with a right bundle branch block pattern. C: Abrupt reduction of LVAT in lead V6 (74 vs 105 ms). LVAT, left ventricular activation time.

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  Figure 2. Left anterior oblique view (30°). Contrast injection confirms perpendicular penetration of stylet-driven lead in the interventricular septum.

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  Figure 3. Echocardiogram, apical-4-chamber view, shows lead position in the right ventricle. Left bundle branch area pacing (LBBAP) lead reached 16 mm of interventricular septum (IVS) penetration and with a 31-mm distance from the tricuspid annulus. Septal myectomy involved the basal region of IVS (∗) and did not affect lead position.

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  Figure 4. Pre- (A) and post- (B) LBBAP implantation 12-lead electrocardiograms. QRS duration shortened from 185 ms to 135 ms, and rsR’ pattern was appreciable in the V1 lead.