A case report: SPEAR-CRT: first description of use of left bundle branch area pacing tools and techniques to place an endocardial LV lead via the interventricular septum in a patient with ostial coronary sinus occlusion

We present a complex patient who ultimately benefited from the novel use of LBBAP equipment to place an endocardial LV lead via the interventricular septum in the setting of several prior failed attempts at placing a traditional LV lead through a stenosed CS. No further options remained for this patient, with palliation as the only alternative. Endocardial LV lead placement should be studied as in future trials as an alternative to traditional transvenous and epicardial CRT systems prior to widespread adoption.