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Direct left bundle branch pacing can result in dyssynchronous left ventricular contraction and worsening heart failure: a case report
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  • Hrak Chemchirian,
  • Michael Orlov,
  • Michael Maysky,
  • James Armstrong
Hrak Chemchirian
Tufts University School of Medicine

Corresponding Author:[email protected]

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Michael Orlov
Tufts University School of Medicine
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Michael Maysky
Tufts University School of Medicine
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James Armstrong
Steward St. Elizabeth's Medical Center
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Abstract

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.