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05-09-2019 | Heart Beat | Uitgave 1/2020 Open Access

Netherlands Heart Journal 1/2020

Left bundle branch area pacing for cardiac resynchronisation therapy

Netherlands Heart Journal > Uitgave 1/2020
L. M. Rademakers
A 72-year-old male patient with complete left bundle branch block (LBBB) with a QRS width of 180 ms (Fig.  2a), left ventricular ejection fraction of 30% and New York Heart Association (NYHA) class III heart failure despite optimal medical therapy was scheduled for implantation of a cardiac resynchronisation therapy defibrillator. The right atrial lead was placed in the appendage, while the right ventricular (RV) shock lead was positioned in a septal position. His bundle pacing failed due to a high capture threshold. Subsequently the 4.1F lumenless 3830 (SelectSecure, Medtronic, Minneapolis, MN, USA) pacing lead was delivered using the C315HIS (Medtronic) sheath in the left bundle branch area by means of a technique described by Huang et al. ([ 1]; Fig.  1). The capture threshold was 0.8 V/0.5 ms. Stimulation of the left ventricular (LV) lead with a short atrioventricular (AV) delay (80 ms) resulted in a typical right bundle branch block with a QRS width of 110 ms. During sequential ‘bi-septal’ pacing (LV 35 ms before RV) with an optimal AV delay (120 ms), the QRS width could be further shortened to 95 ms (Fig.  2b). The patient responded well to therapy, both in NYHA class (II) and echocardiographic measures.

Conflict of interest

L.M. Rademakers declares that he has no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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