Department of Medicine, Faculty of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Thai Red Cross Society, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University, Chulalongkorn University, Bangkok, Thailand.
Pacing Clin Electrophysiol. 2024 Jul;47(7):914-917. doi: 10.1111/pace.14869. Epub 2023 Nov 6.
An 80-year-old man with a history of complete heart block underwent dual chamber pacemaker implantation about a year ago. He returned to the hospital due to de novo heart failure caused by pacing-induced cardiomyopathy; hence, we planned to upgrade his pacemaker to a biventricular device. The initial strategy was to perform left bundle branch area pacing-optimized cardiac resynchronization therapy (LOT-CRT) with left bundle branch area pacing (LBBAP) combined with a coronary sinus (CS) lead. In this challenging case, the successful placement of a CS lead was hindered by a complicated combination of a large CS body linked to the left superior vena cava and a winding CS branch. However, utilizing readily available tools, such as the coronary balloon and Guide Plus II ST catheter, proved instrumental in overcoming these obstacles. As a result, LOT-CRT provided the patient with a safe alternative to surgical LV lead placement.
一位 80 岁男性，既往完全性心脏阻滞，大约一年前行双腔起搏器植入术。因起搏诱导性心肌病导致新发心力衰竭，他返回医院，故我们计划将其起搏器升级为双心室装置。初始策略是采用左束支区域起搏优化心脏再同步治疗（LOT-CRT），结合左束支区域起搏（LBBAP）和冠状窦（CS）导线。在这个具有挑战性的病例中，CS 导线的成功放置受到复杂的 CS 体与左上腔静脉相连和蜿蜒的 CS 分支的阻碍。然而，利用现有的工具，如冠状球囊和 Guide Plus II ST 导管，在克服这些障碍方面发挥了重要作用。结果，LOT-CRT 为患者提供了一种安全的替代手术 LV 导线放置的方法。
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