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Case Reports
. 2022 Sep 21;4(18):1213-1217.
doi: 10.1016/j.jaccas.2022.07.019.

Left Bundle Area Pacing for Tachycardia-Bradycardia Syndrome in a Patient With Dextrocardia

Neil Bodagh  1 , Katarzyna Malaczynska-Rajpold  2 , William Eysenck  1   2 , Matthew O'Connor  2   3 , Tom Wong  2
Affiliations
Case Reports

Left Bundle Area Pacing for Tachycardia-Bradycardia Syndrome in a Patient With Dextrocardia

Neil Bodagh et al. JACC Case Rep. .

Abstract

We present the case of an 81-year-old woman with a background of situs inversus with dextrocardia who was successfully treated for tachycardia-bradycardia syndrome with left bundle area pacing. This report describes how this approach can circumvent the limitations of other pacing approaches to optimize patient outcomes. (Level of Difficulty: Intermediate.).

Keywords: AAIR, atrial-pacing atrial-sensing inhibited-response rate-adaptive (single-lead atrial) [pacemaker]; ACHD, adult congenital heart disease; DDDR, dual-chamber rate-adaptive [permanent pacemaker]; LBAP, left bundle area pacing; dextrocardia; left bundle area pacing; sinus node disease; situs inversus.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Preprocedural Holter Monitoring (A) Recording revealing a 5.25-second pause at 11:37:56. (B) Episode of bradycardia at 16 beats/min at 18:33:10 during Holter monitoring.
Figure 2
Figure 2
Pacemaker Implantation Procedure (A) Right ventriculogram in the left anterior oblique plane. The area outlined in red represents the best area to start screwing in the left bundle area pacing lead based on the venticulogram. (B) Contrast material injection showing the lead deep in the interventricular septum in the right anterior oblique plane. (C) (Right) Original C315 sheath (Medtronic). (Left) Primary curve reversed so that the secondary curve is posteriorly (septally) angulated in a patient with dextrocardia. (D) Chest radiograph (posteroanterior) shows the final position of the pacing system.
Figure 3
Figure 3
Postoperative Electrocardiograms (A) Postimplantation electrocardiogram. QRS complex duration, 110 ms; left ventricular activation time (LVAT) in lead V6, 60 ms. (B) Electrocardiogram showing intrinsic atrioventricular nodal conduction. QRS complex duration, 100 ms.
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