Left Bundle Branch Pacing Across a Bioprosthetic Valve in a Post-Glenn Ebstein's Anomaly With Complete AV Block.

We report a 14-year-old female with a history of surgically corrected Ebstein anomaly, including a bidirectional Glenn shunt and atrial septostomy. Following a bioprosthetic tricuspid valve replacement, the patient developed complete atrioventricular block and became pacemaker-dependent. A unique transvenous approach was utilized: the ventricular lead was advanced from the left axillary vein through the left subclavian vein, superior vena cava, right pulmonary artery, and main pulmonary artery into the right ventricle, resulting in successful left bundle branch pacing. This case illustrates an innovative strategy for permanent physiological pacing in post-Glenn patients.