Left bundle pacing in transposition of the great arteries with previous atrial redirection operation

Figures

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  Figure 1. Electroanatomical map (RAO) with conduction tissue tagged (yellow) and final lead position (green) highlighted. Electrograms from specific locations demonstrate progressive shortening of the “HV interval” with more distal conduction tissue sampling.

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  Figure 2. A: An original C315 sheath (Medtronic, Minneapolis, MN) (left) and the reshaped sheath (right) to adapt for the left bundle pacing in transposition of the great arteries with previous atrial redirection operation. Mustard anatomy with a deep primary curve under the mitral valve and an anterior or right-hand secondary curve to the septum. B: The reshaped C315 sheath in an explanted Mustard heart with the subpulmonary left ventricular free wall reflected to demonstrate the different shape required to reach the left bundle. Dashed lines outline the approximate location of the proximal left bundle conduction system. marks the anterior mitral valve leaflet.

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  Figure 3. A: Fluoroscopic image demonstrating superior vena cava and inferior vena cava baffles and final lead position with reference to the HD grid catheter. B: Presenting electrocardiogram (ECG) demonstrating sinus rhythm, complete AV block, and a narrow complex escape rhythm. C: Final paced ECG demonstrating left bundle capture with almost identical QRS morphology to the intrinsic QRS.