Feasibility of endocardial left bundle branch pacing in a 3-month-old with complete congenital atrioventricular heart block: A case report

Figure 1. First evaluation in our center. A: Patient with a previous scar by sternotomy, presenting with generator extrusion and pocket infection. B: Chest radiograph in an anteroposterior projection showing a definitive epicardial pacemaker with abdominal pocket and a ventricular bipolar lead in the diaphragmatic face of the right ventricle and the other pole in the right ventricular outflow tract. C: Sensing ventricular test in VVI 30, showing atrial sinus rhythm dissociation of the ventricle and absolute pacemaker dependency without escape with a stimulated QRS of 125 ms.

Figure 2. A: Sheath positioned in the right ventricular septum; the lead is over the sheath perforating the interventricular septum. B: The parameters at this position are Stim-LVAT of 50 ms and stimulated QRS with LBBP obtained of 90 ms. C: Final chest radiograph in anteroposterior projection. D: Final electrocardiogram. LBBP = left bundle branch pacing; Stim-LVAT = stimulation latency to local ventricular activation time.

Figure 3. A and B: Photos 3 months after surgery. C: Five months after surgery, weight and height are appropriate for his age, and the thoracic and abdominal scars look better.