Left Bundle Pacing in a Patient with Atrio-Ventricular Canal Defect
Presenting with Atrial Standstill and Junctional Bradycardia
- Kostantinos Aronis,
- Eunice Yang,
- Benjamin T. Barnes,
- Ari Cedars,
- Caridad de la Uz,
- Andreas Barth
Kostantinos Aronis
Johns Hopkins Medicine Division of Cardiology
Corresponding Author:aronisk@upmc.edu
Author ProfileEunice Yang
Johns Hopkins Medicine Division of Cardiology
Author ProfileCaridad de la Uz
Johns Hopkins Medicine Division of Cardiology
Author ProfileAndreas Barth
Johns Hopkins Medicine Division of Cardiology
Author ProfileAbstract
A 37-year-old woman with a history of incomplete atrioventricular canal
and an extensive history of corrective cardiac surgeries presented with
recurrent episodes of acute decompensated heart failure in the presence
of junctional bradycardia with chronotropic incompetence. The initial
plan was to proceed with implantation of a dual chamber pacemaker but
given high index of suspicion for the presence of atrial standstill in
the context of her extensive cardiac surgical history, we performed
electroanatomical mapping and echocardiography at the time of pacemaker
implantation that confirmed atrial standstill. Islands of electrically
functional atrial myocardium were detected. Pacing from these locations
resulted in local atrial capture, but failed to result in global atrial
electrical capture, mechanical atrial contraction, or atrioventricular
conduction. In light of the dismal outcomes of right ventricular pacing
in patients with atrial standstill, we implanted a left bundle branch
pacing lead that resulted in improvement of patient's cardiac output and
prevented future admissions for decompensated heart failure in one year
follow up.