A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease
Abstract Background Left bundle branch area pacing (LBBAP) has emerged as a novel form of physiological pacing. However, few physicians have used stylet-driven pacing leads with a steerable delivery sheath for left fascicular bundle pacing. Case presentation A 75-year-old man with a history of heart...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | International Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42444-023-00098-y |
| _version_ | 1797811983612903424 |
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| author | Hyung Ki Jeong Sung Soo Kim |
| author_facet | Hyung Ki Jeong Sung Soo Kim |
| author_sort | Hyung Ki Jeong |
| collection | DOAJ |
| description | Abstract Background Left bundle branch area pacing (LBBAP) has emerged as a novel form of physiological pacing. However, few physicians have used stylet-driven pacing leads with a steerable delivery sheath for left fascicular bundle pacing. Case presentation A 75-year-old man with a history of heart valve surgery and atrial fibrillation arrived at the emergency department complaining of exertional dyspnea and general weakness. Twelve-lead electrocardiography showed atrial fibrillation with regular RR intervals with escape beats of 41 beats per minutes, which suggested complete atrioventricular block. Two-dimensional echocardiography showed global hypokinesia and a huge atrium. Given the impaired left ventricular (LV) function and the deleterious effects of right ventricular apical pacing, conduction system pacing was attempted. Mapping of His bundle and left bundle potential using a steerable delivery sheath was attempted; however, it did not appear prominent. Several attempts to deploy the lead failed because the sheath was malpositioned such that the lead could not move perpendicularly. Reshaping the sheath allowed for an extended reach so that the pacing lead could be positioned inferior to the previously attempted site toward the apex, deep inside the septum, where the distal left septal fascicle was captured rather than the left bundle branch trunk. During the 6-month follow-up period, the patient was free of any symptoms. Capture threshold and sensing value were stable and follow-up echocardiography showed slightly improved LV function. Conclusions Left fascicular bundle pacing may be an alternative strategy when conventional pacing using stylet-driven pacing leads with a steerable delivery sheath fails to capture the left branch bundle in patients with challenging anatomy. |
| first_indexed | 2024-03-13T07:30:49Z |
| format | Article |
| id | doaj.art-b3c9512225fc48d19ff8d7c18eb02627 |
| institution | Directory Open Access Journal |
| issn | 2466-1171 |
| language | English |
| last_indexed | 2024-03-13T07:30:49Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Arrhythmia |
| spelling | doaj.art-b3c9512225fc48d19ff8d7c18eb026272023-06-04T11:06:41ZengBMCInternational Journal of Arrhythmia2466-11712023-06-012411610.1186/s42444-023-00098-yA successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart diseaseHyung Ki Jeong0Sung Soo Kim1Department of Cardiovascular Medicine, Won Kwang University Medical SchoolDepartment of Cardiovascular Medicine, Chosun University Medical SchoolAbstract Background Left bundle branch area pacing (LBBAP) has emerged as a novel form of physiological pacing. However, few physicians have used stylet-driven pacing leads with a steerable delivery sheath for left fascicular bundle pacing. Case presentation A 75-year-old man with a history of heart valve surgery and atrial fibrillation arrived at the emergency department complaining of exertional dyspnea and general weakness. Twelve-lead electrocardiography showed atrial fibrillation with regular RR intervals with escape beats of 41 beats per minutes, which suggested complete atrioventricular block. Two-dimensional echocardiography showed global hypokinesia and a huge atrium. Given the impaired left ventricular (LV) function and the deleterious effects of right ventricular apical pacing, conduction system pacing was attempted. Mapping of His bundle and left bundle potential using a steerable delivery sheath was attempted; however, it did not appear prominent. Several attempts to deploy the lead failed because the sheath was malpositioned such that the lead could not move perpendicularly. Reshaping the sheath allowed for an extended reach so that the pacing lead could be positioned inferior to the previously attempted site toward the apex, deep inside the septum, where the distal left septal fascicle was captured rather than the left bundle branch trunk. During the 6-month follow-up period, the patient was free of any symptoms. Capture threshold and sensing value were stable and follow-up echocardiography showed slightly improved LV function. Conclusions Left fascicular bundle pacing may be an alternative strategy when conventional pacing using stylet-driven pacing leads with a steerable delivery sheath fails to capture the left branch bundle in patients with challenging anatomy.https://doi.org/10.1186/s42444-023-00098-yArtificial pacemakerBundle of hisAtrioventricular block |
| spellingShingle | Hyung Ki Jeong Sung Soo Kim A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease International Journal of Arrhythmia Artificial pacemaker Bundle of his Atrioventricular block |
| title | A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| title_full | A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| title_fullStr | A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| title_full_unstemmed | A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| title_short | A successful case of left bundle branch area pacing using stylet-driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| title_sort | successful case of left bundle branch area pacing using stylet driven pacing leads with a steerable delivery sheath in patients with structural heart disease |
| topic | Artificial pacemaker Bundle of his Atrioventricular block |
| url | https://doi.org/10.1186/s42444-023-00098-y |
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