Alpha Loop–Assisted Endocardial Pacemaker Lead Implantation in a Patient With Dilated Right Atrium

Right ventricular (RV) lead implantation can be technically challenging, particularly in patients with anatomical variations or a history of cardiac surgery. Innovative lead placement techniques may be required to achieve successful outcomes in such cases. We report the case of an 84-year-old male with a history of degenerative complete heart block and prior cardiac implantable electronic device (CIED) infection, who required re-implantation. Due to a dilated right atrium, RV endocardial lead placement was performed using an alpha loop configuration. This approach enabled successful navigation through complex right atrial (RA) anatomy and stable lead positioning.