Key result
LBBP with AV node ablation completely relieves symptoms in elderly tachycardia-bradycardia syndrome.
Why the study?
The feasibility and outcomes of left bundle branch pacing combined with atrioventricular node ablation in very elderly patients with tachycardia-bradycardia syndrome early after PCI are not well established.
Case Report (n=1)
No
A staged approach of left bundle branch pacing and AV node ablation can provide effective symptom relief and physiological pacing in very elderly patients with tachycardia-bradycardia syndrome who require uninterrupted antithrombotic therapy early after PCI.
Supports LBB pacing plus AV node ablation as feasible in select nonagenarians post-PCI; leaves open confirmation in prospective trials.
We present a 91-year-old female with tachycardia-bradycardia syndrome (TBS) presenting with prolonged asystole up to 8.1 s, 1 month after percutaneous coronary intervention (PCI) while receiving uninterrupted dual antithrombotic therapy (clopidogrel 75 mg daily and rivaroxaban 10 mg daily; aspirin had been discontinued one month after PCI). After failure of antiarrhythmic drug therapy, she underwent left bundle branch pacing (LBBP) without interruption of dual antithrombotic therapy (clopidogrel and rivaroxaban), followed by atrioventricular node ablation (AVNA) for refractory rapid ventricular response. The procedure was successful, with complete relief of syncope, palpitations, and chest pain during the 6-month follow-up measured from AVNA. This case illustrates the feasibility of a staged LBBP and AVNA strategy in a carefully selected very elderly patient with TBS and recent PCI when conventional pharmacological rate control was unsuccessful, and may provide a reference for similar high-risk patients.
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Wang et al. (2026) conducted a case report in Tachycardia-bradycardia syndrome (n=1). Left bundle branch pacing followed by atrioventricular node ablation was evaluated on Relief of syncope, palpitations, and chest pain. Left bundle branch pacing combined with atrioventricular node ablation completely relieved syncope, palpitations, and chest pain over 6 months in a 91-year-old with tachycardia-bradycardia syndrome.
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