Division of Cardiovascular Medicine, Doctor Hung-Pin Wu

The 101-year-old centenarian woman was escorted by her family to the emergency room of CMUH. When she arrived, her heart beat was only 47 beats per minute, while the ECG indicated complete atrioventricular block and pulmonary edema from X-ray results. The doctor had to issue a notice of critical condition and transferred the patient to the Cardiovascular ICU for intensive care. With the detailed explanation, surgical success rate and related risk provided by the medical team, the patient accepted the surgery for left bundle branch pacing under local anesthesia.  Patient Chen recovered well and was transferred to the general ward the next day. Her weak heart and breathing difficulties were substantially improved.

Physician Hung-Pin Wu described complete atrioventricular block as clinically dangerous arrhythmia that could lead to breathing difficulties, dropping blood pressure, passing out, and even sudden cardiac death in patients. Common causes include the block in the atrioventricular node responsible for cardiac conduction due to degeneration, medicine, myocardial infarction, inflammation or cardiomyopathy. The main cure includes a permanent pacemaker treatment. However, the illness is critically related to aging and degeneration, which often occurs in old people. The patient and family often are concerned bout the risk related to the surgery. Therefore, an intensive communication between the doctor and patient should be established with detailed evaluation before the surgery. 

In consideration of the complete atrioventricular block and the total reliance of the patient on pacemaker, Doctor decided to use the novel left bundle branch pacing on the patient after much discussion with the family. Conventional pacemakers are right ventricular pacing based and could result in asymmetry of left ventricular contraction. Consequently, some patients will experience gradually declined cardiac output. Some may suffer from heart failure and need to take surgery again to enhance the left ventricular dilation with cardiac resynchronization therapy. Left bundle branch pacing implants a novel lead into the ventricular septum and the left bundle branch of the conduction system. The existing conduction system of the patient will lead the left and right ventricular pacing to approach the normal ventricular contractions, thereby lower the risk of heart failure due to pacemakers in addition to maintain better cardiac output.

Physician Hung-Pin Wu stated that although the novel bundle branch pacing improves the flaws of conventional pacers, it is not suitable for all patients. Patients are advised to discuss with the doctors and choose the best pacer treatment according to the patients’ conditions.