Addition of an LV lead via the coronary sinus to left bundle branch area pacing can correct dyssynchrony when LBBAP alone fails in patients with severe distal conduction system disease.
Case Report
Does the addition of an LV lead via the coronary sinus improve correction of dyssynchrony in patients with severe distal conduction system disease where LBBAP alone fails?
Left bundle branch-optimized CRT (adding an LV lead) is a useful strategy to correct dyssynchrony when LBBAP alone is insufficient due to severe distal conduction system disease.
Key Teaching Points•Stimulus–time to peak R wave in lead V6 can be longer than expected in left bundle branch area pacing (LBBAP) with left bundle branch capture due to severe distal conduction system disease, which can result in insufficient correction of dyssynchrony.•In patients with nonselective left bundle branch pacing and severe distal conduction system disease, left ventricular (LV) septal myocardium and subsequent LV activation might be faster than LV activation via the (diseased) conduction system, in essence resulting in LV septal pacing only despite capture of the left bundle branch.•Addition of an LV lead via the coronary sinus, resulting in left bundle branch–optimized cardiac resynchronization therapy, can be a good strategy to correct dyssynchrony when LBBAP alone fails to correct dyssynchrony. •Stimulus–time to peak R wave in lead V6 can be longer than expected in left bundle branch area pacing (LBBAP) with left bundle branch capture due to severe distal conduction system disease, which can result in insufficient correction of dyssynchrony.•In patients with nonselective left bundle branch pacing and severe distal conduction system disease, left ventricular (LV) septal myocardium and subsequent LV activation might be faster than LV activation via the (diseased) conduction system, in essence resulting in LV septal pacing only despite capture of the left bundle branch.•Addition of an LV lead via the coronary sinus, resulting in left bundle branch–optimized cardiac resynchronization therapy, can be a good strategy to correct dyssynchrony when LBBAP alone fails to correct dyssynchrony.
Rijks et al. (Sun,) conducted a case report in Severe distal conduction system disease. Left bundle branch-optimized cardiac resynchronization therapy (LBBAP + LV lead) vs. Left bundle branch area pacing (LBBAP) alone was evaluated on Correction of dyssynchrony. Addition of an LV lead via the coronary sinus to left bundle branch area pacing can correct dyssynchrony when LBBAP alone fails in patients with severe distal conduction system disease.