Zero-Fluoroscopy Left Bundle Branch Pacing in Pregnancy Using Electroanatomic Mapping.

BACKGROUND

Left bundle branch pacing (LBBP) offers physiological ventricular activation and has been proposed as an effective pacing strategy in young patients, particularly to prevent pacing-induced cardiomyopathy. In vulnerable populations, such as pregnant women, eliminating fluoroscopy is paramount to avoid fetal radiation exposure.

CASE SUMMARY: We describe a 23-year-old pregnant woman (20 weeks gestation) presenting with symptomatic complete atrioventricular (AV) block. A dual-chamber pacemaker with LBBP was implanted using a three-dimensional (3D) electroanatomic mapping (EAM) system, with complete fluoroscopy avoidance. The procedure was successful and safe, with stable pacing parameters and a favorable maternal-fetal outcome.

CONCLUSION

This case highlights the feasibility and safety of zero-fluoroscopy LBBP guided by 3D EAM in pregnant patients, offering a radiation-free alternative in high-risk scenarios.