case_images: PMC11309990_01
case_images: (A) A diagram of the right bundle branch block before MORROW surgery. The black square indicates that there was a block in the right bundle branch. (B) A diagram of how the left bundle branch has been damaged by the scalpel in MORROW surgery. The rhythm of the ventricle comes from under the block site of the RBB (the blue arrow). (C) A diagram of the His bundle potential recorded by the first 3830 lead. (D) A diagram of the 3830 pacing lead advanced from the right ventricular septum (RVS) to the left ventricular septum (LVS) in the subendocardium, and the lead captured the LBB under the damaged part caused by MORROW surgery (the green arrow). (E) A diagram of 3830 pacing lead capturing the LBB and the myocardium at the same time (the green arrow). (F) A diagram of 3830 pacing lead capturing the LBB and the right ventricular myocardium by the ring at the same time (the green arrow) after planting the permanent pacemaker.
case_images: fcvm-11-1391047-g001.jpg
case_images: PMC11309990_01_fcvm-11-1391047-g001.jpg
case_images: F1
case_images: Ecg showed sinus bradycardia, right bundle branch block (RBBB) and left ventricular hypertrophy (Figures 1A, 2A). After 7 days of observation, ECG still showed 3rd degree AVB (Figures 1B, 2B), so the patient was indicated for permanent dual-chamber pacemaker implantation, and LBBP was performed. A second 3830 lead was implanted to LBBP, and there was an abrupt shortening of Sti-LVAT from 100 ms to 76 ms while the pacing lead advanced from the RVS to the LVS in the subendocardium with a unipolar pacing output of 2 V/0.5 ms (Figures 1D, 2D). The Sti-LVAT remains the same at low and high voltages (2 V and 10 V) (Figures 1E, 2E). The QRS was narrow (124 ms) after implanting the permanent pacemaker, but there was frequent monomorphous ventricular premature beats, and the morphology of the premature ventricle was the same as before the pacemaker was implanted (Figures 1F, 2F).
case_images: (A) ECG before MORROW surgery. ECG showed sinus bradycardia, RBBB and left ventricular hypertrophy (QRS duration:126 ms). (B) ECG showed 3rd degree AVB 7 days after MORROW surgery(QRS duration:130 ms). (C) The His bundle potential follows behind the atrial potential, but it cannot capture the ventricle activation or LBB even at high voltage (10 v/1 ms). (D) There was an abrupt shortening of Sti-LVAT from 100 ms to 76 ms while the pacing lead advanced from the RVS to the LVS in the subendocardium. (E) Sti-LVAT remains the same at low and high voltages (2 V and 10 V). (F) The ECG of the pacemaker, the morphology of the premature ventricle was the same as before the pacemaker was implanted(QRS duration:114 ms). (G) Electrocardiogram at the 6-month follow-up after pacemaker implantation.
case_images: fcvm-11-1391047-g002.jpg
case_images: PMC11309990_01_fcvm-11-1391047-g002.jpg
case_images: F2
case_images: Ecg showed sinus bradycardia, right bundle branch block (RBBB) and left ventricular hypertrophy (Figures 1A, 2A). After 7 days of observation, ECG still showed 3rd degree AVB (Figures 1B, 2B), so the patient was indicated for permanent dual-chamber pacemaker implantation, and LBBP was performed. A second 3830 lead was implanted to LBBP, and there was an abrupt shortening of Sti-LVAT from 100 ms to 76 ms while the pacing lead advanced from the RVS to the LVS in the subendocardium with a unipolar pacing output of 2 V/0.5 ms (Figures 1D, 2D). The Sti-LVAT remains the same at low and high voltages (2 V and 10 V) (Figures 1E, 2E). The QRS was narrow (124 ms) after implanting the permanent pacemaker, but there was frequent monomorphous ventricular premature beats, and the morphology of the premature ventricle was the same as before the pacemaker was implanted (Figures 1F, 2F).