case_images: PMC10734303_01
case_images: (A) Twelve-lead ECG. (B) RA and RV models and labeled His potential. (C) Models of RA and RV in RAO and LAO positions, the position of the lead tip in relation to the labeled HIS, and the recorded left bundle branch potential. (D) The tip of the C315HIS sheath was perpendicular to the septum under ICE. (E) Preoperative ECG with a QRS duration of 120 ms. (F) RV septal pacing ECG with a QRS duration of 145 ms. (G) LBBP ECG with a QRS duration of 110 ms. (H) Lead inserted into the septum at a depth of 9 mm under the ICE. ECG, electrocardiogram; RA, right atrium; RV, right ventricle; LBBP, left bundle branch pacing; SVC, superior vena cava; IVC, inferior vena cava; RAO, right anterior oblique; LAO, left anterior oblique; LV, left ventricle, ICE, intracardiac echocardiography.
case_images: fcvm-10-1325442-g001.jpg
case_images: PMC10734303_01_fcvm-10-1325442-g001.jpg
case_images: F1
case_images: A 28-year-old female patient experienced intermittent dizziness at 18 weeks of gestation, and an electrocardiogram revealed atrial standstill and junctional escape rhythm (Figure 1A). The SVC, RA, and RV maps were created in the CARTO3 system using a PentaRay catheter (Biosense-Webster, USA), and His potential was labeled (Figure 1B). Then, the lead tip was positioned 1.5 cm anterior to the labeled His at the line between the HIS and the RV apex in the system (Figure 1C). On ICE visualization, the C315HIS sheath was oriented so that its tip was perpendicular to the septum (Figure 1D), and the lead tip was gradually screwed into the septum. During gradual screwing, the QRS waveform of the lead tip pacing changed gradually from a "W-shape" to an "M-shape" in V1 leads, and the QRS duration changed from 145 ms in RV septal pacing to 110 ms in LBBP (Figure 1E-G). The left bundle branch (LBB) potential was also recorded (Figure 1C), and the pacing stimulus to LV activation time was 75 ms (Figure 1G). The depth of insertion of the lead tip in the septum was 9 mm, as measured by ICE (Figure 1H).
case_images: (A) The length from the puncture point to the beginning of the thickened 3,830 lead connector was gauged and marked. (B) After removing the C315HIS sheath, the length from the puncture point to the lead marked point was measured again, and remained at 30 cm. (C) The 3,830 lead was advanced by an additional 2.5 cm (27.5 cm from the puncture point to the marked point), keeping the lead slacked to prevent dislocation.
case_images: fcvm-10-1325442-g002.jpg
case_images: PMC10734303_01_fcvm-10-1325442-g002.jpg
case_images: F2
case_images: The length from the puncture point to the beginning of the 3,830 lead connector was assessed and marked (Figure 2A). Then, the C315 sheath was removed and the length from the puncture point to the lead marked point was measured again; it remained unchanged at 30 cm (Figure 2B), ensuring no withdrawal of the deployed lead tip at the LBB. The 3,830 lead was advanced an additional 2.5 cm (27.5 cm from the puncture point to the marked point), with the lead slacked to prevent dislocation (Figure 2C).