Transhepatic Left Bundle Branch Area Pacing in a Patient With Ebstein Anomaly and Prior Glenn Surgery: A First Report.

BACKGROUND

Venous access exhaustion poses a significant challenge for the implantation of intracardiac devices. Epicardial alternatives are often used in these cases, despite their long-term deleterious effects. This case presents a transhepatic approach for left bundle branch pacing in a patient with Ebstein anomaly and a prior Glenn procedure.

METHODS

Following pre-procedural evaluation with triphasic CT, ultrasound-guided hepatic vein puncture was performed. Guidewires were advanced into the right heart chambers, allowing passage of a delivery sheath for physiologic pacing. Atrial lead placement followed.

RESULTS

Appropriate electrical parameters were achieved for both atrial and ventricular leads, with effective biventricular resynchronization via selective left bundle branch pacing.

CONCLUSION

The transhepatic approach is a viable alternative when conventional venous access is not available. Although previously described for traditional pacing systems, this report documents the feasibility of left bundle branch pacing for cardiac resynchronization via the transhepatic route.