Canadian Journal of Cardiology

A Novel Pacing Method to Obtain Synchronous Biventricular Activation: Synchronized Pacing of Left and Right Bundle Branches

Published:October 14, 2022DOI:
      A 69-year-old female patient with intermittent high-grade atrioventricular block and junctional escape rhythm (Fig. 1A) had a history of CRT implantation failure due to tortuous coronary sinus anatomy. Auxiliary examination revealed left ventricular end-diastolic diameter (LVEDD) of 60 mm and ejection fraction (EF) of 35%. The patient was planned for receiving HBP or left/right bundle branch synchronous pacing to achieve synchronous biventricular activation. The patient provided written informed consent.
      Figure thumbnail gr1
      Figure 1(A) 12-lead ECG. (B) Intracardiac electrogram of His bundle, RBB, and LBB potentials. (C) ECG during HBP. (D) ECG during LBBPuni at 1.0 V/0.5 ms. (E) ECG during LBBPuni at 5.0V/0.5ms. (F) ECG during RBBPuni. (G) RAO fluoroscopic projection showed locations of the His catheter and RBBP/LBBP leads. (H) ECG of SUPLR. AV, atrioventricular; ECG, electrocardiography; HBP, His bundle pacing; LBB, left bundle branch; LBBPuni, unipolar LBB pacing; pLVAT, peak left ventricular activation time; pot, potential; RBB, right bundle branch; RBBPuni, unipolar RBB pacing; RAO, right anterior oblique; SUPLR: synchronized unipolar pacing of LBB/RBB.
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