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Left Bundle Branch Area Pacing as a Rescue Strategy After Failed Cardiac Resynchronization Therapy in a Patient With Persistent Left Superior Vena Cava, Absent Coronary Sinus Branches, After Bilateral Maze Procedure: A Case Report.

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Τίτλος: Left Bundle Branch Area Pacing as a Rescue Strategy After Failed Cardiac Resynchronization Therapy in a Patient With Persistent Left Superior Vena Cava, Absent Coronary Sinus Branches, After Bilateral Maze Procedure: A Case Report.
Συγγραφείς: Kohoutková L; Faculty of Electrical Engineering and Computer Science, Department of Cybernetics and Biomedical Engineering, VSB - Technical University of Ostrava, Ostrava, Czech Republic.; Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, Czech Republic., Augustynek M; Faculty of Electrical Engineering and Computer Science, Department of Cybernetics and Biomedical Engineering, VSB - Technical University of Ostrava, Ostrava, Czech Republic., Šipula D; Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, Czech Republic.
Πηγή: The American journal of case reports [Am J Case Rep] 2026 Sep 26; Vol. 27, pp. e952879. Date of Electronic Publication: 2026 Sep 26.
Τύπος έκδοσης: Journal Article; Case Reports
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: International Scientific Information, Inc Country of Publication: United States NLM ID: 101489566 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-5923 (Electronic) Linking ISSN: 19415923 NLM ISO Abbreviation: Am J Case Rep Subsets: MEDLINE
Imprint Name(s): Publication: <2014- > : Smithtown, NY : International Scientific Information, Inc.
Original Publication: Albertson, NY : International Scientific Literature, Inc.
Ιατρικοί όροι (MeSH): Heart Failure*/therapy , Coronary Sinus*/abnormalities , Persistent Left Superior Vena Cava*/complications , Bundle-Branch Block*/therapy , Cardiac Pacing, Artificial*/methods , Cardiac Resynchronization Therapy* , Maze Procedure*, Humans ; Male ; Aged ; Treatment Failure
Περίληψη: BACKGROUND Cardiac resynchronization therapy can fail in the presence of anatomical variations, such as persistent left superior vena cava, which can preclude coronary sinus cannulation and left ventricular lead placement. Conduction system pacing, particularly left bundle branch area pacing, has emerged as a physiological alternative for achieving ventricular resynchronization in such anatomically challenging situations and may provide an effective solution when standard cardiac resynchronization therapy (CRT) is not feasible. CASE REPORT We report the case of a 78-year-old man with chronic heart failure (left ventricular ejection fraction 35%) and a history of mitral valve replacement with a bioprosthesis, tricuspid valve repair, and a bilateral Maze procedure. The patient was indicated for cardiac resynchronization therapy pacemaker (CRT-P) implantation due to sick sinus syndrome with tachy-brady arrhythmia and left bundle branch block with a QRS duration of 190 ms. Periprocedural venography revealed a persistent left superior vena cava draining into a markedly dilated coronary sinus without suitable lateral branches, preventing left ventricular lead placement. Following device implantation, the patient experienced progressive heart failure deterioration, with a decline in left ventricular ejection fraction (LVEF) to 25% and an increase in NT-proBNP to 7741 ng/L, subsequently fulfilling criteria for implantable cardioverter-defibrillator implantation. Due to unfavorable venous anatomy, conduction system pacing (CSP) was selected as an alternative strategy. A right-sided implantable cardioverter defibrillator (ICD) system with left bundle branch area pacing (LBBAP) was successfully implanted, resulting in significant QRS narrowing to 120 ms and excellent pacing parameters. At 2-month follow-up, the patient remained clinically stable (NYHA class II) with improvement in LVEF to 30-35%. CONCLUSIONS This case illustrates that LBBAP can provide effective ventricular activation and resynchronization when conventional CS-based CRT is not feasible due to venous anomalies. LBBAP is a safe and effective alternative in patients with PLSVC and unfavorable CS anatomy.
References: World J Surg Oncol. 2011 Dec 28;9:173. (PMID: 22204758)
Cardiovasc Ultrasound. 2008 Oct 10;6:50. (PMID: 18847480)
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2026 Jun;170(2):71-79. (PMID: 41287952)
J Med Case Rep. 2025 Oct 24;19(1):538. (PMID: 41137155)
Eur Heart J. 2023 Oct 1;44(37):3627-3639. (PMID: 37622666)
Chest. 2001 Jul;120(1):139-44. (PMID: 11451829)
Heart Rhythm. 2023 Sep;20(9):e17-e91. (PMID: 37283271)
Entry Date(s): Date Created: 20260926 Date Completed: 20260926 Latest Revision: 20261001
Update Code: 20261001
DOI: 10.12659/AJCR.952879
PMID: 42800044
Βάση Δεδομένων: MEDLINE
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  Data: Left Bundle Branch Area Pacing as a Rescue Strategy After Failed Cardiac Resynchronization Therapy in a Patient With Persistent Left Superior Vena Cava, Absent Coronary Sinus Branches, After Bilateral Maze Procedure: A Case Report.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Kohoutkov&#225;+L%22&quot;&gt;Kohoutkov&#225; L&lt;/searchLink&gt;; Faculty of Electrical Engineering and Computer Science, Department of Cybernetics and Biomedical Engineering, VSB - Technical University of Ostrava, Ostrava, Czech Republic.; Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, Czech Republic.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Augustynek+M%22&quot;&gt;Augustynek M&lt;/searchLink&gt;; Faculty of Electrical Engineering and Computer Science, Department of Cybernetics and Biomedical Engineering, VSB - Technical University of Ostrava, Ostrava, Czech Republic.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Šipula+D%22&quot;&gt;Šipula D&lt;/searchLink&gt;; Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, Czech Republic.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Heart+Failure%22&quot;&gt;Heart Failure*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Heart+Failure+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Coronary+Sinus%22&quot;&gt;Coronary Sinus*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Coronary+Sinus+abnormalities%22&quot;&gt;abnormalities&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Persistent+Left+Superior+Vena+Cava%22&quot;&gt;Persistent Left Superior Vena Cava*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Persistent+Left+Superior+Vena+Cava+complications%22&quot;&gt;complications&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Bundle-Branch+Block%22&quot;&gt;Bundle-Branch Block*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Bundle-Branch+Block+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cardiac+Pacing%2C+Artificial%22&quot;&gt;Cardiac Pacing, Artificial*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cardiac+Pacing%2C+Artificial+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cardiac+Resynchronization+Therapy%22&quot;&gt;Cardiac Resynchronization Therapy*&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Maze+Procedure%22&quot;&gt;Maze Procedure*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Aged%22&quot;&gt;Aged&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Treatment+Failure%22&quot;&gt;Treatment Failure&lt;/searchLink&gt;
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  Data: BACKGROUND Cardiac resynchronization therapy can fail in the presence of anatomical variations, such as persistent left superior vena cava, which can preclude coronary sinus cannulation and left ventricular lead placement. Conduction system pacing, particularly left bundle branch area pacing, has emerged as a physiological alternative for achieving ventricular resynchronization in such anatomically challenging situations and may provide an effective solution when standard cardiac resynchronization therapy (CRT) is not feasible. CASE REPORT We report the case of a 78-year-old man with chronic heart failure (left ventricular ejection fraction 35%) and a history of mitral valve replacement with a bioprosthesis, tricuspid valve repair, and a bilateral Maze procedure. The patient was indicated for cardiac resynchronization therapy pacemaker (CRT-P) implantation due to sick sinus syndrome with tachy-brady arrhythmia and left bundle branch block with a QRS duration of 190 ms. Periprocedural venography revealed a persistent left superior vena cava draining into a markedly dilated coronary sinus without suitable lateral branches, preventing left ventricular lead placement. Following device implantation, the patient experienced progressive heart failure deterioration, with a decline in left ventricular ejection fraction (LVEF) to 25% and an increase in NT-proBNP to 7741 ng/L, subsequently fulfilling criteria for implantable cardioverter-defibrillator implantation. Due to unfavorable venous anatomy, conduction system pacing (CSP) was selected as an alternative strategy. A right-sided implantable cardioverter defibrillator (ICD) system with left bundle branch area pacing (LBBAP) was successfully implanted, resulting in significant QRS narrowing to 120 ms and excellent pacing parameters. At 2-month follow-up, the patient remained clinically stable (NYHA class II) with improvement in LVEF to 30-35%. CONCLUSIONS This case illustrates that LBBAP can provide effective ventricular activation and resynchronization when conventional CS-based CRT is not feasible due to venous anomalies. LBBAP is a safe and effective alternative in patients with PLSVC and unfavorable CS anatomy.
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  Data: World J Surg Oncol. 2011 Dec 28;9:173. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222204758%22&quot;&gt;22204758)&lt;/searchLink&gt;&lt;br /&gt;Cardiovasc Ultrasound. 2008 Oct 10;6:50. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2218847480%22&quot;&gt;18847480)&lt;/searchLink&gt;&lt;br /&gt;Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2026 Jun;170(2):71-79. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2241287952%22&quot;&gt;41287952)&lt;/searchLink&gt;&lt;br /&gt;J Med Case Rep. 2025 Oct 24;19(1):538. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2241137155%22&quot;&gt;41137155)&lt;/searchLink&gt;&lt;br /&gt;Eur Heart J. 2023 Oct 1;44(37):3627-3639. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237622666%22&quot;&gt;37622666)&lt;/searchLink&gt;&lt;br /&gt;Chest. 2001 Jul;120(1):139-44. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2211451829%22&quot;&gt;11451829)&lt;/searchLink&gt;&lt;br /&gt;Heart Rhythm. 2023 Sep;20(9):e17-e91. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237283271%22&quot;&gt;37283271)&lt;/searchLink&gt;
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      – TitleFull: Left Bundle Branch Area Pacing as a Rescue Strategy After Failed Cardiac Resynchronization Therapy in a Patient With Persistent Left Superior Vena Cava, Absent Coronary Sinus Branches, After Bilateral Maze Procedure: A Case Report.
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