Page 79 - BH-2-1

Brain & Heart

CASE REPORT
A novel pacing strategy for heart block in

bilateral septal pacing: A case report

1
Shanshan He , Wanyu Zhao , Xiaoli Dong , Ke Liu , Yulong Guo , Tao Guo ,
1†
1
1
1
1†
1
1,2
1
Yu Qiao , Guo Dong Niu , Yan Shen *, and Jinrui Guo *
1
1 Department of Arrhythmia, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Beijing,
China
2 Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Abstract
We present the case of a patient referred for conduction system pacemaker
implantation after a complete block associated with transcatheter aortic valve
replacement and reduced left ventricular function. In this case, we achieved bilateral
septal pacing through the anodal capture of the right ventricular septum during
bipolar pacing. This approach generated superior ventricular mechanical synchrony
compared to left ventricular septum pacing (LVSP).

Keywords: Bilateral septal pacing; Left bundle branch pacing; Conduction system pacing
† These authors contributed equally
to the work
*Corresponding authors:
Yan Shen 1. Background
(shenyan@kmmu.edu.cn)
Jinrui Guo Conduction system pacing (CSP) has been suggested as an alternative to address chronic
(sailor2ktg@163.com) right ventricular (RV) pacing-related complications. Left bundle branch pacing (LBBP),
Citation: He S, Zhao W, Dong X, which involves the direct capture of the left bundle branch (LBB), offers an additional
et al. A novel pacing strategy option for CSP with a relatively lower and stable capture threshold. However, the
for heart block in bilateral septal interventricular synchrony resulting from LBBP is not as optimal as with his bundle
pacing: A case report. Brain & 1
Heart. 2024;2(1):1670. pacing due to a longer right ventricle activation time (RVAT). In this report, we detail a
https://doi.org/10.36922/bh.1670 case of complete heart block where successful bilateral septal pacing (BSP) was achieved,
Received: August 24, 2023 effectively mitigating RVAT. A narrower QRS of non-right bundle branch block (non-
RBBB) morphology was observed when a bipolar pacing configuration was adopted in
Accepted: November 21, 2023 this case. This finding indicates that BSP was achieved with the capture of both aspects
Published Online: February 13, of the septum.
2024
Copyright: © 2024 Author(s). 2. Case presentation
This is an Open-Access article
distributed under the terms of the A 77-year-old male with a medical history of coronary artery disease, hypertension,
Creative Commons Attribution hyperlipidemia, and severe peripheral artery disease was diagnosed with severe
License, permitting distribution, symptomatic aortic valve stenosis after presenting with Class III heart failure.
and reproduction in any medium,
provided the original work is Echocardiography revealed a depressed left ventricular ejection fraction of 38%. The
properly cited. initial electrocardiogram (ECG) showed an RBBB (Figure 1). Given the severity of his
symptoms, transcatheter aortic valve replacement (TAVR) was recommended. Following
Publisher’s Note: AccScience
Publishing remains neutral with valve deployment, a complete heart block was observed.
regard to jurisdictional claims in
published maps and institutional Subsequently, the patient underwent dual-chamber pacemaker insertion to address
affiliations. the heart block. A C315HIS sheath (Medtronic, Inc., Minnesota, USA) was introduced

Volume 2 Issue 1 (2024) 1 https://doi.org/10.36922/bh.1670