Key result
Right-sided LBBAP with contralateral tunneling achieves stable pacing thresholds and narrow QRS at 1 month.
Why the study?
Left bundle branch area pacing is increasingly applied for physiological pacing, but lead implantation in patients with left-sided venous anomalies or occlusion remains challenging.
Does right-sided left bundle branch area pacing using a modified sheath technique with contralateral subcutaneous tunneling enable successful lead revision without creating a second pocket in a patient with left brachiocephalic vein occlusion?
Case Report (n=1)
No
Does right-sided left bundle branch area pacing using a modified sheath technique with contralateral subcutaneous tunneling enable successful lead revision without creating a second pocket in a patient with left brachiocephalic vein occlusion?
Right-sided left bundle branch area pacing using a manually bent sheath combined with contralateral subcutaneous tunneling provides a viable salvage option for pacemaker lead revision in patients with left-sided venous occlusion while preserving the original pocket.
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May enable lead revision without new pocket in left venous occlusion; hypothesis-generating for right-sided LBBAP tunneling.
Left bundle branch area pacing (LBBAP) is increasingly applied for physiological pacing but lead implantation in patients with left-sided venous anomalies or occlusion remains challenging. We report a modified sheath technique for right-sided LBBAP with contralateral subcutaneous tunneling to avoid creation of a second pocket, which may theoretically reduce pocket-related complication. A patient with pacemaker lead malfunction presented with persistent left subclavian vein stenosis and left brachiocephalic vein occlusion, precluding standard left-sided revision. Right-sided LBBAP was performed using a C315-His sheath manually bent to 90° to adapt to the right-sided venous trajectory. The newly implanted lead was tunneled subcutaneously across the anterior chest wall to the existing left pectoral pocket, obviating the need for a secondary pocket. Satisfactory pacing parameters were achieved postoperatively, and the patient remained event-free without complications at the 1-month follow-up. Contralateral pacing lead placement combined with subcutaneous tunneling provides a viable salvage option for pacemaker revision in patients with left-sided venous obstruction. This modified sheath technique facilitates right-sided lead implantation, while subcutaneous rerouting maintains the original pocket and precludes the creation of an additional pocket.
Chen et al. (2026) conducted a case report in Pacemaker lead malfunction with left subclavian vein stenosis and left brachiocephalic vein occlusion (n=1). Right-sided left bundle branch area pacing (LBBAP) using a manually modified C315-His sheath (90-degree secondary bend) with contralateral subcutaneous tunneling was evaluated on Procedural success, pacing parameters, and event-free survival at 1-month follow-up. Right-sided LBBAP with contralateral subcutaneous tunneling achieved a 0.9 V pacing threshold at 0.4 ms, 120 ms QRS duration, and 66% LVEF without complications at 1 month.
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