Key result
Left bundle branch area pacing successfully manages alternating bundle branch block from intermittent right bundle conduction delay.
Case Report (n=1)
Alternating bundle branch block can occur due to fixed left fascicular delay combined with intermittent right bundle branch block, which requires permanent pacing.
A 60-year-old gentleman with severe left ventricular systolic dysfunction, multivessel coronary artery disease, and chronic kidney disease presented with New York Heart Association (NYHA) class III breathlessness without any history of syncope or presyncope. The electrocardiogram (ECG) showed sinus rhythm with alternating bundle branch block and a variable PR interval. This was most likely due to consistent conduction delay through the left anterior and posterior fascicles, with intermittent conduction delay or block in the right bundle branch. The patient subsequently underwent dual chamber permanent pacemaker implantation, with the ventricular lead placed at left bundle branch area.
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Sinha et al. (2026) conducted a case report in Alternating bundle branch block (n=1). Dual chamber permanent pacemaker implantation (left bundle branch area pacing) was evaluated. Alternating bundle branch block in a 60-year-old man was attributed to consistent left fascicular conduction delay and intermittent right bundle branch block, treated with permanent pacing.
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