Key result
Left bundle branch area pacing narrowed QRS duration and improved functional status and echocardiographic indices of ventricular systolic function at 3 months in a patient with repaired TOF.
Why the study?
Adults with repaired tetralogy of Fallot frequently develop RBBB-related dyssynchrony and progressive heart failure, and the role of left bundle branch area pacing in this population remains limited.
Does left bundle branch area pacing (LBBAP) improve electrical and mechanical synchrony in adults with repaired tetralogy of Fallot and right bundle branch block?
Case Report (n=1)
Does left bundle branch area pacing (LBBAP) improve electrical and mechanical synchrony in adults with repaired tetralogy of Fallot and right bundle branch block?
Answers are grounded in this paper and cite their sources.
Left bundle branch area pacing (LBBAP) may be a promising physiologic resynchronization strategy to improve electrical and mechanical synchrony in selected adults with repaired tetralogy of Fallot and RBBB.
BACKGROUND: Adults with repaired tetralogy of Fallot (rTOF) frequently develop right bundle branch block (RBBB)-related dyssynchrony and progressive heart failure. The role of left bundle branch area pacing (LBBAP) in this population remains limited. CASE SUMMARY: A 60-year-old man with rTOF presented with monomorphic ventricular tachycardia and worsening heart failure despite being on an optimal medical therapy. After cardioversion, electrocardiography demonstrated sinus rhythm with RBBB and left anterior fascicular block (QRS = 166 ms), while echocardiography revealed biventricular dysfunction with significant mechanical dyssynchrony. A dual-chamber implantable cardioverter-defibrillator with LBBAP was implanted. At 3-month follow-up, QRS duration narrowed, functional status improved, and echocardiographic indices of left and right ventricular systolic function, strain, and myocardial work improved. DISCUSSION: This case suggests that LBBAP may be associated with improved electrical and mechanical synchrony in cases of rTOF with RBBB. TAKE-HOME MESSAGES: LBBAP may represent a promising physiologic resynchronization strategy in selected adults with congenital heart disease and RBBB. Advanced echocardiography can quantify serial changes in ventricular function and mechanics after pacing.
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Karamanolis et al. (2026) conducted a case report in Repaired tetralogy of Fallot (rTOF) with RBBB and heart failure (n=1). Left bundle branch area pacing (LBBAP) was evaluated on Echocardiographic indices of ventricular systolic function, strain, and myocardial work. Left bundle branch area pacing narrowed QRS duration and improved functional status and echocardiographic indices of ventricular systolic function at 3 months in a patient with repaired TOF.
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