Left Bundle Branch Area Pacing as a Rescue Strategy After Failed Cardiac Resynchronization Therapy in a Patient With Persistent Left Superior Vena Cava, Absent Coronary Sinus Branches, After Bilateral Maze Procedure: A Case Report.
Lucie Kohoutková, Martin Augustynek, David Šipula
✦ AI-curated · Sources linked
Case in brief
A 78-year-old man with chronic heart failure and a history of complex cardiac procedures presented for cardiac resynchronization therapy (CRT) due to sick sinus syndrome and left bundle branch block. However, anatomical challenges, including a persistent left superior vena cava and absent coronary sinus branches, precluded standard lead placement. After initial CRT failure and worsening heart function, left bundle branch area pacing was successfully implemented, leading to improved ventricular activation and stabilization of the patient's condition.
What made this case unusual
The case highlights the successful use of left bundle branch area pacing in a patient with persistent left superior vena cava and absent coronary sinus branches, which are significant anatomical challenges for traditional CRT.
Diagnostic / clinical pearl
Clinicians should consider conduction system pacing as a viable alternative for ventricular resynchronization in patients with anatomical variations that complicate standard CRT.
Why it matters
This case underscores the importance of adapting pacing strategies to individual anatomical challenges, potentially improving outcomes in patients with complex cardiac histories.