# Left Bundle Branch Area Pacing to Overcome Coronary Sinus Anatomy-Related Technical Problems Encountered during Implantation of Biventricular CRT—A Case Report

## TL;DR

This case report shows that left bundle branch area pacing can be an effective alternative when traditional biventricular CRT implantation is not possible due to coronary sinus anatomy issues.

## Contribution

The paper presents a novel application of left bundle branch area pacing as a solution to coronary sinus-related CRT implantation challenges.

## Key findings

- Biventricular CRT implantation was not feasible due to poor coronary sinus anatomy in a patient with heart failure.
- Left bundle branch area pacing successfully achieved electrical and mechanical cardiac resynchronization in this case.

## Abstract

The results of clinical trials show that up to one-third of patients who are eligible for cardiac resynchronization therapy (CRT) do not benefit from biventricular pacing. The reasons vary, including technical problems related to left ventricle pacing lead placement in the appropriate branch of the coronary sinus. Herein, we present a case report of a patient with heart failure with reduced ejection fraction and left bundle branch block, in whom a poor coronary sinus bed made implantation of classic biventricular CRT impossible, but in whom, alternatively, rescue-performed left bundle branch area pacing allowed effective electrical and mechanical cardiac resynchronization. The report confirms that left bundle branch area pacing may be a rational alternative in such cases.