High-density mapping-guided corrective HIS bundle pacing after failed CRT upgrade for persistent left superior vena cava

Pacing Clin Electrophysiol. 2020 Jul;43(7):763-767. doi: 10.1111/pace.13931. Epub 2020 Jun 15.

Abstract

In patients with persistent left superior vena cava (PLSVC), transvenous device implantation for cardiac resynchronization therapy (CRT) may be challenging. We present a complex case with successful, high-density electroanatomic mapping (EAM) guided corrective His bundle pacing (CHBP) following failed CRT upgrade in a patient with PLSVC, congenital heart disease, and pacing-associated heart failure. CHBP restored physiological conduction in left bundle branch block with complete conduction block leading to clinical improvement and cardiac remodeling. The presented case supports the growing evidence that EAM-guided CHBP may be considered a feasible alternative to conventional CRT when venous anatomy is not favorable for left ventricular lead implantation.

Keywords: CRT; His bundle pacing; high-resolution mapping; persistent superior vena cava.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bundle of His / physiopathology*
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy*
  • Cardiac Resynchronization Therapy / methods*
  • Epicardial Mapping / methods*
  • Female
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / therapy*
  • Heart Failure / etiology
  • Heart Failure / therapy*
  • Humans
  • Persistent Left Superior Vena Cava / physiopathology
  • Persistent Left Superior Vena Cava / therapy*