He had a history of arterial hypertension and normal coronary angiography. Seventy-five-year-old man was admitted to the cardiology department for treatment of drug refractory supraventricular tachycardia and heart failure (HF). We report a case report of a right-sided LBBAP approach in a patient with a persistent left superior vena cava scheduled for pace and ablate treatment of refractory atypical atrial flutter. Current delivery sheaths are designed for left pectoral implantation, making the right-sided LBBAP lead implantation challenging. Present limitations of CSP might also reflect the early stage of new technology, since there are very limited tools available for wider clinical adoption of this technique. By transeptal lead implantation, LBBAP overcomes some of these limitations making it a more feasible option, especially in the pace and ablate treatment approach. Small target zone, prolonged procedural times, oversensing of atrial signals, need for RV back-up lead, and unstable capture thresholds, especially after AV node ablation are some limitations associated with HBP. With CSP, we have an option of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). With the modification of currently available tools, LBBAP can be performed with the right-sided approach.Ĭonduction system pacing (CSP) is an alternative to standard right ventricular (RV) and biventricular (BiV) pacing in patients scheduled for pace and ablate treatment strategy of refractory supraventricular tachycardias. Radiofrequency ablation of the atrioventricular node was performed the next day and the pacing parameters remained stable in short-term follow-up. With the reshaping of the delivery sheath, we were able to achieve LBBAP with relatively minimal torque. The distance between the reshaping point and the presumed septal region was estimated by placing the sheath on the body surface under fluoroscopy. To enable adequate lead positioning and support for transseptal screwing, the delivery sheath was manually modified with a 90-degree curve at the right subclavian vein and superior vena cava junction to allow right-sided implantation. We report a case of a right-sided LBBAP approach via right subclavian vein in a heart failure patient with a persistent left superior vena cava scheduled for pace and ablate treatment of refractory atrial flutter. However, current delivery sheaths are designed for left-sided implantation, making the right-sided LBBAP lead implantation challenging. Left bundle branch area pacing (LBBAP) is an alternative to right ventricular (RV) and biventricular (BiV) pacing in patients scheduled for pace and ablate treatment strategy.
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