Successful pacemaker implantation using left bundle branch area pacing in a patient with dextrocardia: A case report

Abstract

The left image shows an intraoperative fluoroscopic view with left-right inversion, and the right image is a postoperative noncontrast CT. Both demonstrate the right ventricular lead positioned in the interventricular septum.

Keywords: complete atrioventricular block; dextrocardia; left bundle branch area pacing; pacemaker; stylet‐driven leads.

FIGURE 1

A 12‐lead electrocardiogram at presentation showing complete atrioventricular block with a ventricular rate of 37 beats/min, negative QRS waves in leads I and aVL, and inverted P waves in leads I and aVL.

FIGURE 2

Both the chest radiograph (posteroanterior view) (A) and computed tomography images (B) confirmed that the patient had dextrocardia. Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

FIGURE 3

(A) shows an intraoperative image taken at right anterior oblique 20° and mirrored to simulate a left anterior oblique 20° view. During the procedure, imaging was performed with a setup in which the left–right orientations were reversed. Contrast material injection reveals the lead positioned deep in the interventricular septum in the left–right mirrored image. (B) shows a postoperative image with left–right mirroring.

FIGURE 4

(A) A 12‐lead electrocardiogram after pacemaker implantation, showing reversed arm and leg leads, as well as right‐sided chest leads. (B) The intracardiac electrocardiogram showed a QRS complex duration of 121 ms, a left ventricular activation time of 76 ms in lead V6, and a V6–V1 interpeak interval of 39 ms.