Direct left bundle branch pacing can result in dyssynchronous left
ventricular contraction and worsening heart failure: a case report
A 69 year old male patient with mild non ischemic cardiomyopathy,
baseline EF of 47%, received a dual chamber pacemaker with a direct
left bundle branch lead for complete heart block. 3830 lead was inserted
intraseptally according to published recommendations with a resultant
QRS of 103 ms. One month later patient presented with severe heart
failure. Echocardiogram showed significant dyssynchrony and EF of 21%.
Patient remained highly symptomatic despite aggressive medical therapy
and exclusion of other causes of heart failure. An upgrade to a
bi-ventricular pacing system was performed. At 1 month follow up,
patient was no longer exhibiting heart failure symptoms, EF had improved
back to baseline (46%) with improvement in dyssynchrony.