Introduction: : In children with atrioventricular (AV) block and pacemaker (PM) indication, the degree of pacing-induced dyssynchrony varies between the different pacing sites.
Case report: A 12-year-old child, with heart failure was treated by cardiac transplantation and developed transient graft failure managed with ECMO during 48 hours. A postoperative complete AV block occurred and a PM was indicated. To avoid LV desynchronization was proposed a transvenous dual chamber PM using isolated LV pacing via coronary sinus (CS). A guiding catheter was introduced into left subclavian vein and placed into the CS to perform a venogram. An endocardial pacing lead with active fixation mechanism was implanted into the anterior inter-ventricular vein branch. A second pacing lead was implanted at the right atrium. The leads were secured and connected to a dual chamber PM (Fig. 1,2). The post implant echocardiographic evaluation showed absence of inter-ventricular and intraventricular dyssynchrony.
Results:
Conclusions: With the development of dedicated, transvenous, LV leads with active fixation mechanism, ventricular pacing via the CS is a viable and safety option to perform isolated LV pacing in children with AV block.