What is the clinical evidence from this study?

Study design: Case Report. Population: Complete atrioventricular block with double-chambered left ventricle and perimembranous ventricular septal aneurysm (n=1). Intervention: Left bundle branch area pacing (LBBAP) with transoesophageal echocardiography (TEE) guidance. Primary outcome: Feasibility and pacing parameters at 1-year follow-up.

What does this research mean for the field?

Left bundle branch area pacing (LBBAP), guided by multimodality imaging and intraoperative transoesophageal echocardiography, is a feasible physiological pacing option for patients with complex congenital heart defects such as double-chambered left ventricle and perimembranous ventricular septal aneurysm. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To report the feasibility and technical implementation of left bundle branch area pacing in an adult presenting with complete atrioventricular block and rare coexisting congenital cardiac anomalies.

September 14, 2026European Heart Journal - Case ReportsOpen Access

Left bundle branch pacing in double-chambered left ventricle and perimembranous ventricular septal aneurysm: a case report

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Key result

TEE-guided LBBAP proves feasible with stable pacing parameters maintained at 1 year.

Why the study?

Is left bundle branch area pacing feasible and safe in a patient with complete AV block, double-chambered left ventricle, and perimembranous ventricular septal aneurysm?

Key Points

To report the feasibility and technical implementation of left bundle branch area pacing in an adult presenting with complete atrioventricular block and rare coexisting congenital cardiac anomalies.
Evaluated a 31-year-old man presenting with exertional dyspnoea, complete atrioventricular block (escape rhythm of 42 bpm), a double-chambered left ventricle, and a large perimembranous ventricular septal aneurysm (N=1).
Performed conduction system pacing with left bundle branch area pacing under general anaesthesia using fluoroscopy, intracardiac electrograms, and adjunctive transoesophageal echocardiography to avoid septal abnormalities.
Transseptal lead deployment into the undivided muscular septum achieved conduction system engagement with a stimulus to peak of R wave interval in lead V6 of 80 ms and a V6–V1 interpeak interval of 40 ms.
Final left bundle branch area pacing parameters demonstrated a transition threshold of 1.5 V, a left ventricular septal capture threshold of 0.5 V at 0.5 ms, pacing impedance of 700 Ω, and R-wave amplitude of 11.0 mV, remaining stable at 1-year follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Is left bundle branch area pacing feasible and safe in a patient with complete AV block, double-chambered left ventricle, and perimembranous ventricular septal aneurysm?

Population

1 31-year-old man with complete AV block, double-chambered left ventricle, and perimembranous ventricular septal aneurysm followed for 1 year.

Intervention

Left bundle branch area pacing (LBBAP) guided by intraoperative transoesophageal echocardiography (TEE).

Outcome

Feasibility, safety, and pacing parameters at 1-year follow-up.

LBBAP is a feasible physiological pacing option even in patients with complex and rare congenital heart defects like DCLV and PMSA when guided by TEE.

Limitations

Long-term outcome data on LBBAP in rare congenital anatomical variants remain limited

Implication

May enable TEE-guided LBBAP in rare congenital septal anomalies; leaves open broader safety and efficacy in congenital heart disease.

Abstract

Background Double-chambered left ventricle and perimembranous ventricular septal aneurysm are rare congenital heart abnormalities that often remain undetected until adulthood. Both abnormalities can be associated with conduction disorders requiring cardiac pacing. To our knowledge, this is the first case report of a patient with both a double-chambered left ventricle and a perimembranous ventricular septal aneurysm, undergoing left bundle branch area pacing (LBBAP) due to complete atrioventricular (AV) block. Case summary A 31-year-old man with complete AV block was admitted to our centre, where diagnostic evaluation revealed a complex congenital heart defect: a large perimembranous septal aneurysm and a double-chambered left ventricle. Due to high predicted pacing burden, conduction system pacing with LBBAP was attempted. In addition to the standard technique, transoesophageal echocardiography (TEE) was used intraoperatively to facilitate safe positioning of the LBBAP lead. Finally, engagement of the conduction system was confirmed and preserved at the 1-year follow-up, with stable pacing parameters. Discussion Conduction system pacing in congenital heart defects can be technically challenging due to complex anatomy. This case highlights LBBAP as a feasible physiological pacing option, even in complex and rare congenital heart defects. To minimise procedural risk, careful preprocedural multimodality imaging and intraoperative utilization of TEE were essential for optimal lead positioning in the setting of abnormal septal structures.

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Published by European Heart Journal - Case Reports · CC BY

Cite This Study

Brečko et al. (2026) conducted a case report in Complete atrioventricular block with double-chambered left ventricle and perimembranous ventricular septal aneurysm (n=1). Left bundle branch area pacing (LBBAP) with transoesophageal echocardiography (TEE) guidance was evaluated on Feasibility and pacing parameters at 1-year follow-up. Left bundle branch area pacing with intraoperative transoesophageal echocardiography guidance was feasible and resulted in stable pacing parameters at 1-year follow-up.

synapsesocial.com/papers/6aa7afef79e9260bc85aace7 https://doi.org/10.1093/ehjcr/ytag681

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Implication

May enable TEE-guided LBBAP in rare congenital septal anomalies; leaves open broader safety and efficacy in congenital heart disease.

Left bundle branch pacing in double-chambered left ventricle and perimembranous ventricular septal aneurysm: a case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Left bundle branch pacing in double-chambered left ventricle and perimembranous ventricular septal aneurysm: a case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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