left bundle branch area pacing has emerged as a novel modality of conduction system pacing which is feasible and safe, with rare complications and a high success rate. In this article, we report the case of a woman with obstructive hypertrophic cardiomyopathy who developed a complete heart block after an alcohol septal ablation procedure. To our knowledge, this is the first case report of this type of pacing in a patient. We want to show that this procedure is safe and can be successful, as well as the possible limitations in this scenario. 

Left bundle branch pacing in a patient with hypertrophic myocardiopathy and complete heart block after alcohol septal ablation.

Our case report shows that left bundle branch pacing may be safe and feasible in patients who have undergone alcohol septal ablation, despite concerns over potential difficulties with lead implantation and capture. Introduction Alcohol septal ablation (ASA) is a minimally invasive therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) whereby nonsurgical reduction of the hypertrophied septum is induced via injection of ethanol into the first septal perforator. This improves symptoms through reduction of left ventricular (LV) outflow tract obstruction. Electrophysiological complications of this procedure include bradyarrhythmia and tachyarrhythmia, such as atrial fibrillation (AF). Refractory AF can be treated with atrioventricular (AV) nodal ablation and permanent pacemaker implantation. Newer pacing modalities have been developed that may improve patient outcomes, such as left bundle branch pacing (LBBP). This strategy has not previously been described in a patient who has undergone ASA. LBBP has been considered challenging in these patients, as ASA can cause fibrosis in the septal region of interest, which could theoretically lead to difficulties with lead implantation and subsequent successful capture.

Atrioventricular nodal ablation and left bundle branch pacing for treatment of refractory atrial fibrillation post alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

Advanced Cardiac Life Support Algorithms.

To the Editor—Left bundle branch pacing as cause for takotsubo cardiomyopathy?

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Atrioventricular nodal ablation and left bundle branch pacing for treatment of refractory atrial fibrillation post alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

Advanced Cardiac Life Support Algorithms.

To the Editor—Left bundle branch pacing as cause for takotsubo cardiomyopathy?