Key result
His-bundle pacing achieves ~10% LVEF improvement and QRS narrowing in a subclavian stenosis case.
Why the study?
Venous occlusion and unsuitable coronary sinus anatomy complicate upgrades to biventricular pacing in patients with pacing-induced cardiomyopathy.
Case Report (n=1)
No
His-bundle pacing can serve as an effective bailout therapy for patients requiring biventricular pacing who have occluded venous access and unsuitable coronary venous anatomy.
Answers are grounded in this paper and cite their sources.
May support bailout use in CRT candidates with venous occlusion; hypothesis-generating pending prospective data.
We present an interesting case of an 88-year-old man who was referred to our arrhythmia service for an upgrade of his dual-chamber pacemaker to a biventricular pacemaker for right ventricular pacing-induced cardiomyopathy. The patient was found to have stenosis of the left subclavian vein. Here, we describe the approach used to perform venoplasty in this patient. After venoplasty of the left subclavian vein, the patient did not have suitable coronary venous anatomy for deployment of the coronary sinus lead. Subsequently, a His lead was implanted. We achieved significant narrowing of the QRS with good thresholds and other lead parameters. Through this case report, we seek to present our approach of venoplasty in patients with occluded venous access for either an upgrade or a de novo implant.
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Rashid et al. (2022) conducted a case report in Right ventricular pacing-induced cardiomyopathy and subclavian vein stenosis (n=1). His-bundle pacing was evaluated on Ejection fraction and QRS narrowing. His-bundle pacing successfully achieved QRS narrowing and improved ejection fraction from 40% to 50% at 3 months in a patient with subclavian stenosis and no suitable coronary sinus branch.
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