Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 7090-7096
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7090
Left bundle branch pacing in a ventricular pacing dependent patient with heart failure: A case report
Bing-Xue Song, Xia-Xia Wang, Yi An, Ying-Ying Zhang
Bing-Xue Song, Xia-Xia Wang, Yi An, Ying-Ying Zhang, Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Song BX and Wang XX were the patient’s bedside clinicians, reviewed the literature and contributed to manuscript drafting; An Y reviewed the literature and contributed to the manuscript; Zhang YY was responsible for the revision of the manuscript for important intellectual content; Song BX, Wang XX and Zhang YY performed the operation; All authors issued final approval for the version to be submitted.
Informed consent statement: The informed consent has been signed by the patient.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Ying Zhang, MD, Staff Physician, Department of Cardiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266000, Shandong Province, China. doczhangyingying@yeah.net
Received: December 17, 2021
Peer-review started: December 17, 2021
First decision: February 21, 2022
Revised: March 3, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: July 16, 2022
Abstract
BACKGROUND

Left bundle branch pacing (LBBP) is a physiological pacing method that has emerged in recent years. It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy (CRT). Moreover, LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy. However, LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.

CASE SUMMARY

A 69-year-old male patient presented with symptoms of chest tightness, palpitation and systolic heart failure with New York Heart Association class III for 1 mo. The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat. Holter revealed a right bundle branch block, atrial fibrillation with third-degree atrioventricular block, frequent multifocal ventricular premature beats, Ron-T and ventricular tachycardia. The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction. Coronary angiography indicated a stenosis of 30% in the middle left anterior descending artery. Apparently, a CRT-D pacemaker was the best choice for this patient according to previous findings. However, the patient was worried about the financial burden. A single-chamber pacemaker with LBBP was selected, with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time. During the follow-up at 3 mo after LBBP, the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters, and the New York Heart Association functional class was maintained at I. Moreover, the patient no longer suffered from chest tightness and palpitation. Holter showed decreased ventricular arrhythmia of less than 5%.

CONCLUSION

LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.

Keywords: Left bundle branch area pacing, Physiological pacing, Heart failure, Cardiac resynchronization therapy, Pacing-dependent, Case report

Core Tip: Left bundle branch pacing is a new and prospective pacing technique that is a promising alternative with the potential for similar outcomes in patients with complete left bundle branch block who need cardiac resynchronization therapy or for patients with pacemaker-induced cardiomyopathy. We present herein a patient with heart failure and high-degree atrioventricular block treated with left bundle branch pacing who received improved cardiac function during follow-up. This case highlights the possibility of left bundle branch pacing used in patients who already have heart failure and high-degree atrioventricular block as an alternative to conventional cardiac resynchronization therapy.