Left bundle branch area pacing from the iliac approach in a patient without superior access: a case report.

BACKGROUND

Left bundle branch area pacing (LBBAP) emerges as an alternative to traditional right ventricular pacing, demonstrating safety and feasibility through superior access for implantation.

CASE SUMMARY: An 89-year-old female, with a prior history of pacemaker pocket infection and a tricuspid endocarditis during follow-up, was referred to our hospital for management due to a sinus arrest. The patient underwent pacemaker removal due to a pocket infection in the right subclavian area, necessitating tricuspid valvuloplasty for infective endocarditis. Venography revealed occlusion in the left brachiocephalic vein. Subsequently, LBBAP pacemaker implantation via the right iliac vein was performed, with follow-up indicating proper functioning of the pacing system.

DISCUSSION: The feasibility of the right iliac vein access for LBBAP implantation is highlighted, demonstrating good stability and offering a practical alternative. This approach mitigates unnecessary risks associated with thoracotomy and epicardial lead placement, providing a safer and effective option for cardiac pacing.