Left bundle branch pacing optimized right ventricular resynchronization in a patient with severe right ventricular dilatation

Cardiac resynchronization therapy (CRT) is an effective treatment for patients with left bundle branch block (LBBB) and left ventricular (LV) dyssynchrony. Left bundle branch area pacing (LBBAP) has recently emerged as a promising physiological alternative to conventional right ventricular pacing (RVP) and CRT [1,2], but may lead to significant right ventricular (RV) dyssynchrony, which might affect clinical outcomes in a specific group of patients [3]. Here, we present a case of successful right ventricular cardiac resynchronization therapy (RV-CRT) achieved by combining LBB pacing (LBBP) with RV lateral wall pacing to restore ventricular synchrony in a patient with intermittent atrioventricular (AV) conduction disease and severe RV dilatation due to an unrepaired atrial septal defect.