Abstract
A 79-year-old man with non-ischaemic cardiomyopathy, no scar at magnetic resonance, and left ventricular ejection fraction (LVEF) of 24%. He had permanent atrial fibrillation, New York Heart Association functional class II , and left bundle branch block (Panel A). Under the suspicion of a tachycardiomyopathy component, we chose physiological pacing to allow optimization of pharmacological rate control therapy. Left bundle branch pacing (LBBP) was performed, obtaining two types of capture: non-selective, with narrow QRS with 2.25 V to 0.4 ms output (Panel B) and selective with right bundle branch block morphology at 2 V to 0.4 ms (Panel C). Same morphology with monopolar and bipolar pacing. The high output obtained Plus-LBBP recruiting both branches; low output recruited only the left branch, Pure-LBBP. X-ray (Panel D) shows LBBP lead (arrows) and a backup lead in the right ventricular apex, both connected...
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