# Left bundle branch area pacing from the iliac approach in a patient without superior access: a case report

## TL;DR

A new method for heart pacing was successfully used in a patient through the iliac vein, avoiding risks from traditional approaches.

## Contribution

Demonstrates the feasibility of using the right iliac vein for left bundle branch area pacing in patients with superior access limitations.

## Key findings

- LBBAP implantation via the right iliac vein was successfully performed in an 89-year-old patient.
- The pacing system functioned properly during follow-up.
- This approach avoids thoracotomy and epicardial lead placement risks.

## Abstract

Left bundle branch area pacing (LBBAP) emerges as an alternative to traditional right ventricular pacing, demonstrating safety and feasibility through superior access for implantation.

An 89-year-old female, with a prior history of pacemaker pocket infection and a tricuspid endocarditis during follow-up, was referred to our hospital for management due to a sinus arrest. The patient underwent pacemaker removal due to a pocket infection in the right subclavian area, necessitating tricuspid valvuloplasty for infective endocarditis. Venography revealed occlusion in the left brachiocephalic vein. Subsequently, LBBAP pacemaker implantation via the right iliac vein was performed, with follow-up indicating proper functioning of the pacing system.

The feasibility of the right iliac vein access for LBBAP implantation is highlighted, demonstrating good stability and offering a practical alternative. This approach mitigates unnecessary risks associated with thoracotomy and epicardial lead placement, providing a safer and effective option for cardiac pacing.