Abstract
Left bundle pacing in transposition of the great arteries with previous atrial redirection operation
Highlights
Transposition of the great arteries (TGA) is a congenital heart defect characterized by concordant atrioventricular (AV) and discordant ventriculoarterial connections leading to 2 parallel circulatory systems
There are a number of operations that have been performed over the years to surgically palliate this parallel circulation; currently the arterial switch operation is the standard of care
The Mustard operation consists of the superior vena cava (SVC) and inferior vena cava being rerouted via surgical baffle to the vestibule of the left atrium, with the subsequent redirection of systemic venous blood to the subpulmonary left ventricle (LV)
Summary
Transposition of the great arteries (TGA) is a congenital heart defect characterized by concordant atrioventricular (AV) and discordant ventriculoarterial connections leading to 2 parallel circulatory systems. Left bundle pacing (whereby the pacing lead is tunneled through the ventricular septum to the left bundle area) has developed as a viable alternative.[8] Owing to the position deep in the septum, the issues of both microdislodgement and direct His bundle injury are addressed It has been employed in the adult congenital heart disease (ACHD) population, such as in congenitally corrected TGA.[9] the implant complexity increases in TGA, as implant tools—namely the C315 sheath (Medtronic, Minneapolis, MN)—are designed to implant a lead into a septum in the usual anatomical arrangement, where the ventricular septum is located posteriorly within the right ventricle instead of the anterior angulation required when implanting via a subpulmonary LV. The resultant QRS duration (142 ms) and morphology were almost identical to that of the intrinsic QRS
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