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Direct left bundle branch pacing can result in dyssynchronous left ventricular contraction and worsening heart failure: a case report
  • +1
  • Hrak Chemchirian,
  • Michael Orlov,
  • Michael Maysky,
  • James Armstrong
Hrak Chemchirian
Tufts University School of Medicine
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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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Peer review status:IN REVISION

20 Jun 2020Submitted to Journal of Cardiovascular Electrophysiology
22 Jun 2020Assigned to Editor
22 Jun 2020Submission Checks Completed
23 Jun 2020Reviewer(s) Assigned
03 Jul 2020Review(s) Completed, Editorial Evaluation Pending
04 Jul 2020Editorial Decision: Revise Minor


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.